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THE 



AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES. 



COLLABORATORS. 



Jacob Bigelow, M. D. Professor of 
Materia Medica in Harvard Univer- 
sity, Boston. 

Walter Chaining, M. D. Professor of 
Midwifery and Legal Medicine in 
Harvard University, Boston. 

N. Chapman, M. D. Professor of the 
Institutes and Practice of Physic and 
Clinical Practice in the University of 
Pennsylvania. 

John Redman Coxe, M. D. Professor 
of Materia Medica and Pharmacy in 
the University of Pennsylvania. 

William C. Daniele, M. D. of Savan- 
nah, Georgia. 

J. B. Davidge, M. D. Prof essor of Ana- 
tomy in the University of Maryland. 

E. De Butts, M. D. Professor of Che- 
mistry in the University of Maryland. 

William P. Dewees, M. D. Aaljunct 
Professor of Midwifery in the Univer- 
sity of Pennsylvania. 

S. Henry Dickson, M. D. Professor of 
the Institutes and Practice of Medicine 
in the Medical College of S. Carolina. 

Benjamin W. Dudley, M. D. Profes- 
sor of Anatomy and Surgery in Tran- 
sylvania University. 

Gouverneur Emerson, M. D. of Phila- 
delphia. 

Thomas Fearn, M. D. of Alabama. 

John W. Francis, M. D. Professor of 
Obstetrics and Forensic Medicine in 
Rutgers Medical College, New York. 

William Gibson, M. D. Professor of 
Surgery in the University of Pennsyl- 
vania. 

John D. Godman, M. D. late Prof essor of 
Anatomy and Physiology in Rutgers 
Medical College, New York. 

R. E. Griffith, M. D. of Philadelphia. 

E. Hale, M. D. of Boston. 

R. Hare, M. D. Professor of Chemistry 
in the University of Pennsylvania. 

Isaac Hays, M. D. one of the Surgeons 
of the Pennsylvania Infirmary for 
diseases of the Eye and Ear. 

George Hayward, M. D. of Boston. 

Thomas Henderson, M. D. Professor 
of the Theory and Practice of Medi- 
cine in the Columbian College, Dis- 
trict of Columbia. 



William E. Horner, M. D. Adjunct 
Professor of Anatomy in the Univer- 
sity of Pennsylvania. 

David Hosack, M. D. Professor of the 
Institutes and Practice of Medicine in 
Rutgers Medical College, New York. 

Ansel W. Ives, M. D. of New York. 

Samuel Jackson, M. D. Assistant to the 
Professor of the Institutes and Practice 
of Medicine and Clinical Practice in 
the University of Pennsylvania. 

Samuel Jackson, M. D. of Northum- 
berland, Pennsylvania. 

Frederick G. King, M. D. of New 
York. 

W. J. Macneven, M. D. Professor of 
Therapeutics and Materia, Medica in 
Rutgers Medical College, New York. 

C. B. Matthews, M. ~D. of Philadelphia. 

Valentine Mott, M. D. Professor of 
Surgery in Rutgers Medical College, 
New York. 

James Moultrie, Jr. M. D. of Charles- 
ton, S. C. 

Reuben D. Mussey, M. D. Professor 
of Anatomy, Surgery, and Obstetrics 
in Dartmouth College. 

James M. Pendleton, M. D. Lecturer 
on Midwifery and Diseases of Women 
and Children, New York. 

Philip Syng Physick, M. D. Profes- 
sor of Anatomy in the University of 
Pennsylvania. 

Nathaniel Potter, M. D. Professor of 
the Theory and Practice of Medicine 
in the University of Maryland. 

Thomas Sewall, M. D. Professor of 
Anatomy and Physiology in the Co- 
lumbian College, District of Columbia. 

John Spence, M. D. of Dumfries, Vir- 
ginia. 

John Ware, M. D. of Boston. 

John C. Warren, M. D. Professor of 
Anatomy and Surgery in Harvard 
University, Boston. 

J. Webster, M. D. Lecturer on Ana- 
tomy and Surgery, Philadelphia. 

N. W. Worthington, M. D. Professor 
of Materia Medica in the Columbian 
College, District of Columbia. 

Thomas H. Wright, M. D. Physician to 
the Baltimore Aims-House Infirmary. 



THE 



AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES 



VOL. IV. 



PHILADELPHIA: 

CAREY, LEA AND CAREY— CHESNUT STREET 

1829. 



^Vf-HSO/Y/^x 




* library 




SKERHETT NINTH 8TIIEET ? 

PHILADELPHIA. 



£10,5 
ABO 
v.H 

ftoi. 



TO READERS AND CORRESPONDENTS. 

As by recent arrangements, we have acquired many new readers, who may 
be perhaps unacquainted with the peculiar plan and objects of this Journal, 
it is proper to say a few words on the subject. The American Journal of the Me- 
dical Sciences was commenced in November, 1827. The design of those con- 
cerned in its publication was to establish a National Work, devoted exclusive- 
ly to the improvement of medical science, and to elevate the character and dig- 
nity of the profession, to the entire rejection of all local and individual inte- 
rests and partt views. To effect these objects, a large number of the distinguish- 
ed medical men in every part of the union associated, and most of them have al- 
ready contributed to the work. In the selection of original papers, the editors 
have had reference to practical interest, and have inserted only such as they be- 
lieved would convey useful information at home, and be creditable to the coun- 
try abroad. The communications already published, are from almost every sec- 
tion of the union, and as the editors never regard themselves as arbiters of 
medical opinion, exhibit great diversity of views. 

In the department of Reviews and Bibliographical Notices, the editors endea- 
vour to make their readers acquainted at the earliest period possible with all 
works, both foreign and domestic, which contain useful information — passing- 
by those of little or no interest, except where the authority of a name gives 
sanction to what appear dangerous doctrines: in all cases, free criticism is 
admitted, when conducted with candour, and in that temperate and cour- 
teous tone which alone comports with the dignity of science. The articles in 
this department are likewise by various writers. 

The Periscope is devoted to the annunciation of improvements in medicine; 
for which purpose most of the medical journals of Europe and this country are 
procured, and the editors have also access to the valuable libraries of the differ- 
ent scientific institutions of this city. Every new publication is carefully ex- 
amined — all the useful information briefly noticed — and many of the most valua- 
ble papers given in a condensed form — thus presenting a complete summary 
of the progress of medical science. The articles are arranged according to their 
subjects under distinct heads. This plan is preferable to that of analyzing each 
Journal separately, as it affords to the inquirer direct reference to the imme- 
diate object of his research — saves much time and labour — and space is not oc- 
cupied with worthless matter, often to the exclusion of what is useful, as must 
occur where there is no liberty of selection. Great attention is devoted to this 
department, and it is believed that it will be found to embrace, in addition 
to the interesting matter contained in the periodical publications, a mass of 
facts from new works to which access could not otherwise readily be ob- 
tained. 

Anonymous communications are never admitted. The editors are, conse- 
quently, allowed a greater freedom of selection, without compromising their 
own opinions, and criticism is more surely restricted within proper bounds. 



VI TO READERS AND CORRESPONDENTS. 

The responsibility for articles not signed rests with the immediate editor, Dr. 
Hays. 

Having originated under the influence of physicians belonging to the differ- 
ent states, and most of the medical schools of the union; exclusively devoted 
to the honour and advancement of professional reputation and usefulness; un- 
shackled by sectional, party, or personal feelings, it is not surprising that the 
American Journal of the Medical Sciences should have received a support from 
American physicians, perhaps unexampled in the history of similar enterprises. 
The principles which have induced this result, the same catholic and elevated 
views of duty which have hitherto actuated its conductors, will continue to de- 
termine their course and control their proceedings. An undeviating regard to 
the great interests of the profession, and an unabated ardour in the cause 
of truth and science, will exclude all personalities, so universally the off- 
spring of irritated egotism, as well as prevent the Journal from condescending 
to notice the attacks of such as conceive themselves aggrieved by a plan which 
denies admission to articles unsuited to advance the great cause of medical 
science, or unworthy the organ of a liberal and dignified profession. 

The medical public are deeply interested in the success of this work, and 
they are invited to furnish to it their contributions. 

Communications have been received from Dr. Daniell, of Savannah; Dr. 
Pendleton, of New York; Dr. Peirce, of Sutton, Massachusetts: and Dr, Wells, 
of Maracaybo. 

Also the following works : — 

Description of the Distinct, Confluent, and Inoculated Small-Pox, Varioloid 
Disease, Chicken-Pox, and Cow-Pox. Illustrated by thirteen Plates. By John 
D. Fisher, M. D. (from the author.) 

A system of Dental Surgery. In three parts. I. Dental Surgery as a science. 
II. Operative Dental Surgery. III. Pharmacy connected with Dental Surgery. 
By Samuel Sheldon Fitch, M. D. Surgeon Dentist, (from the author.) 

A Biographical Memoir of Wright Post, M. D. late Professor of Anatomy and 
Physiology, and President of the College of Physicians and Surgeons in the 
City of New York. Delivered as an Introductory Lecture, on the 4th of No- 
vember, 1828. By Valentine Mott, M. D. Professor of Surgery in Rutgers 
College, New York, (from the author.) 

Transactions of the Medical Society of the State of New York, for the year 
1829. With the Annual Address. By T. Romeyn Beck, M. D. President of 
the Society, (from the Society.) 

An Oration delivered before the Central Medical Society of Georgia, at its 
annual meeting in Milledgeville, on 2d December, 1828. By Alexander Jones, 
M. D. (from the author.) 

Journal des Progres des Sciences et Institutiones Medicales en Europe en 
Amerique, &c. Vol. XII. 

Annales de la Medecine Physiologique, November and December, 1828, and 
January, 1829. 

Revue Medicale, &c. October and December, 1828. 



TO READERS AND CORRESPONDENTS. Vli 

Journal G£ne>al de Me"decine, &c. September, October, and November, 
1828, and January, 1829. 

Archives Generates de M^decine, November and December, 1828, and Janu- 
ary, 1829. 

Bulletin des Sciences Me*dicales, November, 1828. 

Journal Universel des Sciences Medicales for December, 1828, and January, 
1829. 

Journal Hebdomadaire de Medecine. Par MM. Andral, Blandin, Bouil- 
laud, A. Cazenave, Dalmas, Littre, Reynaud, H. Royer-Collard, Vol. I. 
Nos. 1, 2, 3, and 4. 

Litterarische Annalen der gesammten Heilkunde. Herausgegeben von Dr. 
J. F. C. Hecker, February, March, October, and November, 1828, (in exchange.) 

Rust's Magazin fur die gesammte Heilkunde, 1827, (in exchange.) 

Gemeinsame deutsche Zeitschrift fiir Geburtskunde, (in exchange.) 

Notizen ans den Gebiete der Natur und Heilkunde, gesammelt und mitget- 
heilt. Von Ludwig Fr. Von Froriep, 1828, (in exchange.) 

The Medico- Chirurgical Review, for January, 1829, (in exchange.) 

The London Medical and Surgical Journal, for December, 1828, and Janu- 
ary and February, 1829, (in exchange.) 

The London Medical and Physical Journal, for December, 1828, and Janu- 
ary and February, 1829, (in exchange.) 

London Medical Gazette, December, 1828, (in exchange.) 

Boston Medical and Surgical Journal, Vol. I. Nos. 49 to 52, inclusive, and 
Vol. II. Nos. 1 to 9, inclusive, (in exchange. ) 

The North American Medical and Surgical Journal, April, 1829, (in ex- 
change.) 

The Transylvania Journal of Medicine and the Associate Sciences, February, 
1829, No. 1, (in exchange.) 

Transylvania Journal of Medicine and the Associate Sciences. Extra. I. Mr. 
W. P. Nicholson's Pamphlet, and II. Dr. B. W. Dudley's Reply, (from the 
editors. ) 

The Western Journal of the Medical and Physical Sciences, for November, 
1828, and January and February, 1829, (in exchange.) 

The New York Medical and Physical Journal, Vol. I. No. 4, (in exchange.) 

For the gratification of our contributors we continue the references to the 
works, in which they will find notices of their communications; these references 
are, of course, restricted to the Journals received during the preceding three 
months. 

Professor Mott will find his Case of Ligature of the Common Iliac Artery 
copied into Froriep's Notizen, for April, 1828. 

Professor Dickson's paper on Dengue is reviewed in the Western Medical 
and Physical Journal, for November, 1828, 



Vlll TO READERS AND CORRESPONDENTS. 

Dr. Spence's Case of Pulmonary Consumption is copied into the Journal 
Universel, for October, 1828. 

Dr. Wright's paper on the Reunion of Fractured Bones is copied into the 
London Medical and Physical Journal, and reviewed in the London Medical and 
Surgical Journal. 

Dr. Mitchell's Cases of Dysentery are copied into the London Medical and 
Physical Journal, for December, 1828. 

Dr. Kain's paper on Intemperance is noticed in the Medico-Chirurgical Re- 
view, January, 1829. 

Dr. De Leon's Case of Schirro-Contracted Rectum is noticed in the Medico- 
Chirurgical Review, for January, 1829. 

Dr. Arnold's Case of Paruria Erratica is noticed in Froriep's Notizen, for 
July, 1828. 

Dr. Pennock will find his Experiments on the use of Cupping^Glasses in 
Poisoned Wounds, reviewed and translated in the Journal des Progr£s, Vol. XII. 

Dr. Heiskell's Case of Extra-Uterine Fcetation is copied into the Archives 
Generates, for December, 1828. 

Dr. Powell's Case of Excision of the Spleen is copied into Froriep's Notizen, 
for July, 1828. 

Dr. Griffith's Case of Salivation is noticed in the Archives Generales, for 
December, 1828. 

Authors of new medical books, desirous of having them reviewed or noticed 
in this Journal at the earliest opportunity, are invited to transmit to the Editors 
a copy as soon after publication as convenient, when they will receive prompt 
attention. Under ordinary circumstances, very considerable delay is caused 
by the circuitous routes through which they are received. 

Papers intended for publication, should be sent,/ree of expense, as early after 
the appearance of the Journal as possible, in order to be in time for the en- 
suing number. Such communications should be addressed to " Carey, Lea 
& Caret, Philadelphia, for the Editors of the American Journal of the Medical 
Sciences." All letters on the business of the Journal to be addressed exclu- 
sively to the publishers. 



CONTENTS 



ORIGINAL COMMUNICATIONS. 

ESSAYS. 
Art. Page. 

I. Experiments on the use of metallic ligatures, as applied to arteries. By 
Henry S. Levert, M. D. of Alabama 17 

II. Reports of Cases of Erysipelas, treated at the Baltimore Alms-house 
Infirmary, showing the countervailing influence of that disease over other 
affections existing in the system at the time of its invasion, with Observa- 
tions. By Thomas H. Wright, M. D. Physician to the Institution. - 23 

III. Remarks on the Use of Prussic Acid. By George Hayward, M. D. of 
Boston 49 

IV. Contributions to the Physiology and Pathology of the Nervous System. 
By W. E. Horner, M. D. Adjunct Professor of Anatomy in the Univer- 
sity of Pennsylvania 54 

V. On the Contagious Nature of Dengue. By S. H. Dickson, M. D. Pro- 
fessor of the Institutes and Practice of Medicine in the Medical College 

of South Carolina - - 62 

VI. Case of Wound of the Femoral Artery successfully treated. By Wil- 
liam G. Dickinson, M. D. of Franklin, Tennessee - - - 69 

VII. Experiments to prove the Existence of a Peculiar Physico-organic 
Action, inherent in Animal Tissues, called Endosmose and Exosmose. 

By Joseph Togno, M. D. - - 73 

VIII. On the Seat and Treatment of Erysipelas. By Alexander Somervail, 

M. D. of Essex County, Virginia. - - - - - - 92 

IX. Case of Epilepsy, successfully treated by the Operation of Trepanning. 

By James Guild, M. D. of Tuscaloosa, Alabama 96 

X. Remarks on a Cutaneous Affection, produced by certain Poisonous Ve- 
getables. By R. Dakin, M. D. of Columbus, N. J. - - - - 98 

XI. On Hydrorachitis, with Cases. By Solomon Temple, M. D. of Phila- 
delphia -..--.-----.- 100 

MEDICAL EDUCATION AND INSTITUTIONS. 

XII. Account of the Hopital de la Pitie, Hopital de St. Antoine, Hopital 
Necker, Hopital Cochin, and Hopital Beaujon at Paris. By Elisha Bart- 
lett, M. D. of Lowell, Mass. 117 

REVIEWS. 

XIII. Pathological and Practical Researches on Diseases of the Stomach, 
the Intestinal Canal, the Liver, and other Viscera of the Abdomen. By 
John Abercrombie, M. D. Fellow of the Royal College of Physicians of 
No. VIL— May, 1829. 2 



X CONTENTS. 

Edinburgh, &c. and First Physician to his Majesty in Scotland. Edin- 
burgh, 1828, pp. 396, 8vo. - 123 

XIV. A Practical Treatise on Parturition, comprising the Attendant Cir- 
cumstances and Diseases of the Pregnant and Puerperal States. By Sa- 
muel Ashwell, Member of the Royal College of Surgeons, and the Me- 
dico-Chirurgical Society of London. To which are appended two Pa- 
pers, the one containing some Remarks on Abdominal Surgery, the other 
on Transfusion; presented by Dr. Blundell, of Guy's Hospital. London 
1828, pp. 546, 8vo. with 13 plates 145 

BIBLIOGRAPHICAL NOTICES. 

XV. On Aneurism, and its Cure by a New Operation. Dedicated by per- 
mission to the King. By James Wardrop, Surgeon to his Majesty. Lon- 
don, 1828, pp. 117, 8vo. 166 

XVI. Memoires de PAcade'mie Royale de M^decine. Tome Premier. Avec 

six Planches. Paris, J. B. Bailliere, 1828, 4to. pp. 496 - - 169 

XVII. A Treatise on the Nature and Cure of Intestinal Worms of the 
Human Body; Arranged according to the Classification of Rudolph and 
Bremser, and containing the most approved methods of treatment, as 
practised in this country, [England,] and on the continent [of Europe.] 
By William Rhind, Surgeon, Member of the Royal Medical Society of 
Edinburgh. Illustrated by six plates. London, 1829, pp. 142 - - 176 

XVIII. De l'Irritation et de la Folie, ouvrage dans lequel les rapports du 
Physique et du Moral sont etablis sur les bases de la Medecine Physiolo- 
gique. Par F. J. V. Broussais. Paris, 1828, pp. 590, 8vo. - - 180 

XIX. Histoire Philosophique et Medicale des Hemorrhagies, de leurs 
Causes Essentielles, Imrnediates ou Prochaines, et des Methodes de 
traitement qu'il convient d'employer dans cette classe de Maladies. Par 
D. Latour, Docteur en Medecine, Ancien Medecin de l'Hotel Dieu 
d'Orleans, &c. Tom. 2. Oct. pp. 1016. Paris, 1828 - 186 

XX. Du Degre de Competence des M£dicins dans les Questions Judiciaires 
relative aux Alienations Mentales, et des Theories Physiologiques sur la 
Monomonie. Par Elias Regnault. Paris, 1828, pp. 207, 8vo. - - 189 

XXI. Myology, Illustrated by Plates, in four parts. Part I. Muscles of the 
Anterior part of the Thigh, Leg, and Foot. Part II. Muscles of the An- 
terior and Posterior part of the Arm and Hand. Part III. Muscles of 
the Abdomen and Back. Part IV. Muscles of the Face and Eye, Ante- 
rior and Posterior part of the Neck, with the Muscles of the Perineum, 
completing the whole of the muscles of the Human Body. By Edward 
William Tuson, House Surgeon to the Middlesex Hospital, London 
1825, folio, pp. 8. Plates. 

A Supplement to Myology, containing the Arteries, Veins, Nerves, and 
Lymphatics of the Human Body, the Abdominal and Thoracic Viscera, 
the Ear and Eye, the Brain, and the Gravid Uterus, with the Foetal Cir- 
culation. By Edward William Tuson, Lecturer on Anatomy and Physio- 
logy, Member of the Royal College of Surgeons in London, &c. &c. 
London, 1828, folio, pp. 9. Plates. 192 

XXII. Gemeinsame deutsche Zeitschrift fiir Geburtskunde, von einem Ve- 



CONTENTS, 



XI 



reine von Geburtshelfern. Herausgegeben (lurch D. W. H. Busch, L. 
Mende, und F. A Ritgen. Band 3. Heft 2. Weimar, 1828 

XXIII. Transactions of the Medical Society of the State of New York, for 
the year 1829. With the Annual Address. By T. Romeyn Beck, M. D. 
President of the Society. Albany, 1829, pp. 20, 8vo. 

XXIV. An Epitome of the Physiology, General Anatomy, and Pathology 
ofBichat. By Thomas Henderson, M. D. Professor of the Theory and 
Practice of Medicine in the Columbian College, Washington City. Phi- 
ladelphia, 1829, pp. 326, 8vo. 

XXV. A System of Dental Surgery. In three parts. Part I. Dental Sur- 
gery as a Science. — II. Operative Dental Surgery. — III. Pharmacy Con- 
nected with Dental Surgery. By Samuel Sheldon Fitch, M. D. Surgeon 
Dentist. New York, 1829, pp. 568, 8vo. With 3 plates - 

XXVI. Description of the Distinct, Confluent, and Inoculated Small-Pox, 
Varioloid Disease, Cow-Pox, and Chicken-Pox. Illustrated by 13 Co- 
loured Plates. By John D. Fisher, M. D. Boston, Wells & Lilly, 1829. 
pp. 73, folio 



193 



194 



195 



196 



196 



QUARTERLY PERISCOPE. 

FOREIGN INTELLIGENCE. 



ANATOMY. 



Case in which the Uterus was 
wanting. By Dr. Breschet - 197 

Anomalous distribution of the 
Vascular System in a New-born 
Child. By Professor Mende ib. 

Singular Biceps Muscle. By 
Mr. C. M. Barnett - - ' ib. 



Recurrent Laryngeal Nerve. By 
G. Rainey - - - - 

Proper Nerve of the tensor mus- 
cle of the Tympanum, or of the 
internal mucle of the Maleus 



198 



ib. 



Physiology. 



6. Experiments on Circulation, 
Absorption, and Secretion. By 

M. E. Hering 198 

7. On Reunion of the Ends of Dif- 
ferent Nerves. By M. Flourens 200 

8. On Identical Active Molecules 
in Organic and Inorganic Bo- 
dies. - - - - -- ib. 

9. Effects produced by a division 
of the Semicircular Canals of the 
Ear. By M. Flourens - - 201 

10. Researches on the Pollen of 
Plants and the ultimate Particles 

of Matter .... ib. 

11. Successive Abolition of the 
Senses in four children of the 
same family. By Dr. Stengel 202 



12. Experiments on Cutaneous 
Absorption. By Dr. Westrumb 

13. On Poisoning of Plants by their 
own Products. By M. Macaire 

14. On the Effects of the Gastric 
Juice on the Stomach after 
Death, and on Abstinence. By 
Dr. Pommer ... 

15. Case of Menstruation at the 
age of nineteen months 

16. On the Connexion between 
Monstrosity and Deficient De- 
velopment of parts of the Ner- 
vous System. By Professor Tie- 
demann - 

17. On the Powers which move 
the Blood in the Capillary Sys- 
tem. By Dr. F. F. Reuss - 



203 



205 



ib. 



206 



ib. 



ib. 



XII 



CONTENTS. 



Pathology. 



Page. 

18. General Induration of the Ar- 
terial System ... 208 

19. Case of almost complete Obli- 
teration of the Aorta - - ib. 

20. Account of Dr. Gall's Disease. 

By Dr. Robouam - - 210 

21. On Hypertrophy of the Brain. 

By M. Dance 212 

22. Case of Psoas Abscess, point- 
ing' on the Anterior part of the 
Dorsum Ilii. - - - 213 

23. Case of Suppuration of the 
Spleen. By Dr. Glionna - 214 

24. Case in which Bone was found 

in the Heart. By»Dr. Barbier ib. 

25. Case of perforation of the Duo- 
denum. By M. Robert - ib. 

26. On Dysentery. By Dr. Chris- 
tison - 215 



Page. 

27. On a Disease of the Stomach, 
which produces a well defined 
perforation of its tunics, without 
softening of their surrounding 
structure. By Dr. Ebermaier 215 

28. Singular case of Insanity caused 
directly by a fall on the Head. 
By Dr. Hausbrand 

29. Case of Disease of the Blad- 
der, terminating in perforation 
and fatal extravasation of its con- 
tents. By M. Thevissen 

30. Case of Paralysis of the Right 
Side, with Affection of the same 
Side of the Brain. By Dr. Leuret 218 

31. Case of Cartilaginous Degene- 
ration of the Stomach. By Dr. 
Dieffenbach - - - ib. 



216 



217 



32. Laxative of Senna and Prunes 

33. On Variolaria Amera as a sub- 
stitute for Quinquina. By M. 
Cassebeer - 



Materia Medica. 
218 



219 



34. Discovery of a new species of 
Cinchona. By M. Gondat - 219 

35. Purgative property of Convol- 
vulus Sepium ... ib. 

36. Effects of Bitter Almonds. ib. 



Practice of Medicine. 



37. Case of Gastro-entero-cephali- 
tis, attended with malignant 
symptoms, and successfully 
treated. By M. Broussais - 

38. On the Hydrocyanate of Iron 
as a substitute for Quinine. By 
Dr. Hasse - 

39. Method of arresting Bleeding 
from Leech-bites. By S. Ridalfo 224 

40. On Hydriodate of Potash as a 
Cure for Cynanche Parotidea. 
By Dr. Neumann 

41. On Transfusion. By Dr. Dief- 
fenbach .... 

42. Transfusion in a Still-born 
Child. By Dr. Dieffenbach 

43. On Bleeding in the cold stage 
of Intermittent Fever. By Dr. 
Stokes .... 

44. Itch cured by Chloride of Lime 

45. On Brome as a cure for Scro- 
fula and Goitre. By Dr. Pourche 

46. On the treatment of Metallic 
Colic by Sulphate of Alumine. 
By M. D. Montanceix 

47\ Cases of Transfusion in Hydro- 



219 



223 



ib. 



ib. 



225 
ib. 

ib. 



lb. 



phobia. By Drs. Dieffenbach 
and Mayer . 226 

48. Pustular Venereal Eruption, 
treated by the Subcarbonate of 
Ammonia .... 227 

49. Case of Psoriasis Inveterata, 
successfully treated by the Ar- 
senical Solution. By M. Biett ib. 

50. Incipient Paralysis cured by 
Bleeding from the Arm. By M. 
Broussais - 228 

51. Treatment of Hydrophobia 
with Chlorine. By MM. Sem- 
mola and Schoenberg - ib. 

52. Fumigation of Belladonna in 
Phthisis Pulmonalis. By Profes- 
sor Cruveilhier - ib. 

53. New Mode of treating Taenia, 
discovered by Dr. Schmidt, of 
Berlin, and described by M. Cas- 
par, by order of the Prussian go- 
vernment ... - 229 

54. Case of Neuralgia Facialis. By 
Dr. Campagno - - - 230 

55. Treatment of Dysentery. By 
Dr. Christison - - - ib. 



CONTENTS, 



Xlli 



Ophthalmology- 



Page. 

56. Complete Amaurosis cured by 
the application of Leeches to 
the Nasal Fossae. By Dr. Guepi- 
net - 231 

57. Singular Tumour in the Eye, 



Page, 
successfully extirpated. By H. 
Clarke, Esq. 231 

58. Case of Fungous of the Globe 
of the Eye successfully extirpa- 
ted. By W. Twining, Esq. 232 



Surgery. 



59. Wound of the Femoral Artery 
successfully treated. By M. Lis- 
franc 233 

60. Stricture of the Urethra cured 
by a Mercurial Treatment. By 
Professor Graefe - - 234 

61. Case of Strangulated Hernia 
presenting a remarkable pecu- 
liarity. By Dr. Ehermann - 235 

62. Cases of Laryngitis, in which 
Bronchotomy was successfully 
performed. By Dr. Couper ib. 

63. Treatment of Strictures of the 
Urethra - - - - 237 

64. Fatal error in the diagnosis of 

a tumour. By Dr. Krimer - ib. 

65. On the Removal of loose sub- 
stances from the Knee-joint. By 
Charles Averill, Esq. - ib. 

66. On Lithotrity. By Mr. Zanabi 
Pecchioli 239 

67. On Hydrocele. By Professor 
Graefe 240 

68. White Swelling successfully 
treated by Frictions of Iodine. 

By Dr. Lugol ... ib. 

69. Aneurism of the Carotid cured 

by the method of Valsalva - ib. 



70. Case of Aneurismal Condition 
of the Posterior Auricular and 
Temporal Arteries, successfully 
treated by an Operation. By 
James Syme, Esq. - - 240 

71. Case of Hernia, Strangulated 
at the Superior Internal Orifice 
of the Inguinal Canal. By Dr. 
Ouvrard .... 242 

72. Treatment of Fractures of the 
Inferior Extremities by Conti- 
nued Extension. By M. Josse ib. 

73. Extirpation of a Wen. ByM. 
Lisfranc - ib, 

74*. Reduction of a Luxation of five 
months standing. By M. Lisfranc 

75. Aneuri sm by Anastomosis, suc- 
cessfully treated by tying the 
Carotid. By Dr. Arendt 

76. Aneurism of the Right Primi- 
tive Carotid successfully treated. 

By Dr. A. Molina - - ib, 

77. Amputation without applying 
Ligatures to the vessels - ib. 

78. Needle in the Larynx, remov- 
ed by Laryngotomy. By M. 
Blandin .... ib. 



ib. 



24. 



Midwifery. 



79. Injection of Vinegar and Wa- 
ter into the Umbilical Vein in 
cases of Uterine Haemorrhage, 
depending upon Retention of 
the Placenta. By Dr. Jemina 244 

80. Report of Midwifery. By Mr. 
Mantel - 

81. Case of Difficult Labour in 
consequence of the Enlarged 
State of the Kidneys of the Foe- 
tus. By Professor Osiander 

82. On Absorption by the Uterus. 
By Dr. F. C. Naegele 



ib. 



ib. 



83. Table of Labours in the Clinic 
of Heidelberg, from the 1st of 
January, 1825, to the 31st of De- 
cember, 1826. By Professor 
Naegele .... 245 

84. Case of Retroversion of the 
Womb. By J. P. Ouvrard - 246 

85. Case of Premature Birth, at- 
tended with some uncommon 
Circumstances. By J. J. Cribb, 
Esq. ib. 



XIV 



CONTENTS. 



Medical Jurisprudence. 



Page. 

86. Case of Premature Birth of a 
Living" Child, without the intro- 
duction of Air into the Lungs. 

By Dr. J. P. Ouvrard - 247 

87. Case in which an Infant cried 
previous to its Expulsion from 
the Organs of Generation, with 
conclusions which may be de- 
duced from it, connected with 



Page 
Medical Jurisprudence. By Dr. 
J. P. Ouvrard - 

88. Case of Vagitus Uterenus. By 
M. Lesaurage - - . 

89. Remarkable Symptoms pro- 
duced by Poisoning with Bella- 
donna. By M. Jolly - 

90. Case of Rupture of the Blad- 
der. By Mr. Delvar - - 250 



248 



249 



ib. 



Chemistry. 



91. New Compound of Silica and 
Potassa. By M. Fuchs - 251 

92. Discovery of the Mode of mak- 
ing the Diamond. By M. Ganal ib. 

-93. On the Nature of Aloetic Acid. 

By M. Liebeg 252 

94. On Sugar of Liquorice. By M. 
Berzelius - ib 



95. Iodine Detected in the Blood. 

By M. Bennerscheidt - - 253 

96. OnBenzoic Acid in the Grasses. 

By M. Vogel - - - ib. 

97. On a New Alcali in the Eu- 
patorium Cannabium. ByM. Ri- 
ghini ib. 



Miscellaneous. 



98. Medical Statistics of the Ne- 
therlands 253 

99. Medical Profession in St. Pe- 
tersburgh .... 254 

100. Duration of Human Life in 
Russia - ib. 

101. Maison des Enfans trouv£s at 

St. Petersburgh ... ib. 

102. Infirmary for Diseases of the 
Eye at St. Petersburgh - ib. 



103. Bristol Infirmary for Diseases 

of the Eye 255 

104. Mode of Preserving Speci- 
mens of Morbid Anatomy. By 
John S. Gaskoin - - ib, 

105. On the Supposed Change of 
Climate. By Professor Schouw ib. 

106. Epidemic at Paris - - 256 



AMERICAN INTELLIGENCE. 



A Case of the deleterious effects 
of Opium on an Infant. By C. 
Drake, M. D. of New York 

On Pyroligneous Acid in Sphace- 
lus, and Foetid Ulcers. By Dr. 
Thomas Y. Symons, of Charles- 
ton 

Case of Injury of the Head. By J. 
W. Heustis, M. D. of Alabama 

Case of Deformed Pelvis, in which 
Delivery was successfully effect- 
ed, embryulcia having been 
performed in two preceding 
Pregnancies. By William M. 
Fahne stock, M. D. 

Medical Statistics. By I. Hays, 
M. D. - - 

On the Employment of Cotton as 



257 



258 



259 



260 



a Dressing for Blisters. By Dr. 

A. P. Merrill, of Natchez - 260 

Case of Preternatural Membrane 
in the Vagina. By William Hall 
Richardson, M. D. Professor of 
Obstetrics in Transylvania Uni- 
versity - ib. 

Account of the Dengue, as it pre- 
vailed at Antigua, West Indies. 
By Thomas Nicholson, Surgeon ib. 

On the Use of Opium in Inflamma- 
tory Diseases. By F. G. King, 
M. D. of New York. Commu- 
nicated in a letter to Professor 
V. Mott 262 

Case of Gunshot Wound of the 
Lungs and Heart. By Dr. Leo- 
nard Randal, of Tennessee - 263 



CONTENTS, 



XV 



Page. 

Biographical Memoir of Wright 
Post, M. D. By Professor Mott 264 

Essay on the Structure, Functions, 
and Diseases of the Nervous Sys- 
tem. By John R. W. Dunbar, 
M. D. of Virginia - - ib. 

The Western Journal of the Me- 
dical and Physical Sciences ib. 

Beclard's Elements of General 
Anatomy - ib. 

University of Pennsylvania— Com- 
mencement held March 21st, 
1829 265 



Page. 

Transylvania University Com- 
mencement held March 10th, 
1829 268 

Medical College of South Carolina 
— Commencement held March 
23d, 1829 - 

Columbian College, District of Co- 
lumbia — Commencement held 
March 11th, 1829 - - 

Philadelphia Medical Society 

Philadelphia Vaccine Institution 



270 



271 
ib. 

272 



THE 

AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES 



Art. I. Experiments on the use of Metallic Ligatures, as applied to 
Jlrteries. By Henry S. Levert, M. D. of Alabama. 

Dr. JONES, in the course of his interesting experiments "on the 
process employed by nature in suppressing the haemorrhage from di- 
vided and punctured arteries, and on the use of the ligature," arrived 
at a very striking result 5 one that seemed likely to lead to an im- 
portant innovation in the application of the ligature. He found that 
if a ligature be drawn around an artery with a degree of force suffi- 
cient to divide its internal and middle coats, the subsequent inflam- 
mation and effusion of coagulable lymph produced its obliteration, 
and the ligature might be removed, and the wound healed by the first 
intention. 

Had these conclusions been found by subsequent inquirers to be 
correct, we might have considered it a degree of perfection in the use 
of the ligature, beyond which we can never hope to proceed; but un- 
fortunately, others who have investigated this subject, have arrived 
at conclusions somewhat different, and have found that although an 
evident contraction of the calibre of the vessel, was the almost inva- 
riable result of an application of the ligature as recommended by Dr. 
Jones 5 yet its complete obliteration was seldom observed. 

Mr. B. Travers imagined that the cause of failure in these cases 
proceeded from a too speedy removal of the ligature, before the sides 
of the vessel had time to contract the slightest adhesions, and im- 
proving upon the idea of Dr. Jones, has advised that it be suffered 
to remain on the vessel for a short time, until adhesions should be 

No. VII.— May, 1829. 3 



18 Levert on Metallic Ligatures applied to Arteries. 

established between the opposing sides; by which means he hoped to ' 
secure invariably the desired result. 

To ascertain the truth of this reasoning, he instituted a number of 
experiments upon inferior animals, and actually realized the results 
which he had anticipated. Since the publication of his paper, the 
practice he recommended has been extended to the human subject, 
and in some cases has been attended with the happiest effects; in 
others, however, it has failed entirely, and has even been productive 
of the very worst consequences. The length of time necessary for the 
ligature to remain on the vessel, the inconveniences which result 
from a wound kept open forty-eight or seventy-two hours, and the 
doubtful effects of the ligature unless suffered to remain on for 
that period, are obstacles which must always prevent this practice 
from being adopted. It therefore remains for future inquirers to 
discover some means by which that direful malady, aneurism, can 
be alleviated, without those unpleasant consequences which inva- 
riably attend the present mode of operating, if indeed such a result 
be attainable. 

Some years ago Dr. Physick suggested the propriety of an animal 
ligature, thinking that it would be removed by the absorbents; the 
external wound might therefore be closed, and all the bad effects 
produced by the ordinary ligatures thus obviated. We cannot say 
positively what has been the result of this practice, but believe that 
the animal ligature is not used so much as its importance demands. 

The same gentleman has likewise suggested the use of leaden liga- 
tures, with the view of obtaining such results as were hoped for from 
his animal ligature, or the temporary one of Dr. Jones. To this he 
was led by a knowledge of the fact, that bullets, buck-shot, and lead 
would remain in contact with almost any tissue of the body, without 
producing irritation or unpleasant consequences, and that for an in- 
definite period. So far as I know, a trial of this ligature has never 
been made; with a view, therefore, to ascertain its effects, I have 
instituted a number of experiments, the results of which I will now 
relate. 

Experiment I. — On the 16th of May, 1828, I laid bare the right 
carotid artery of a dog, and, after separating it carefully from its ac- 
companying nerve and vein, I passed under it a lead wire, and tied 
it firmly. Both ends of the wire were then cut off with a pair of 
scissors, and the sharp points bent down with a common dissecting 
forceps. The wound was now drawn together with a few stitches of 



Levert on Metallic Ligatures applied to Jlrteries. 19 

the interrupted suture, and over these were laid some adhesive 
strips. This animal was not confined, but suffered to run at large: 
when I examined him several days after, I found the stitches ulce- 
rated out, and the wound open,* it had filled up from the bottom with 
granulations, but the edges of the skin were separated to a consider- 
able distance: with light dressings, it healed entirely by the 5th of 
June. 

June %8th. — I killed this animal and dissected with care the neck. 
A small cicatrix existed in the skin; the lead was found in the situa- 
tion in which I had placed it, by the side of the vein and nerve, per- 
fectly encysted; the artery at this place had been removed entirely, 
for the space of half an inch. 

Both ends of the vessel, caused by this removal of its central por- 
tion, adhered by loose cellular substance to the surrounding parts, 
which appeared to be in a perfectly natural state. The end towards 
the heart was not at all increased or diminished in size; it was sealed 
up for three-eighths of an inch in extent, by an organized substance, 
resembling a coagulum of blood in colour, but not in consistence, it 
being much firmer. The end towards the head resembled the one 
just described, in all particulars: the substance, however, which filled 
its extremity was of greater extent, and occupied the whole space up 
to the next branch, which was rather more than half an inch. 

Not the slightest trace of inflammation existed in the neighbouring 
parts, on the contrary, they appeared perfectly natural. The lead 
itself was enclosed in a dense cellular substance, which formed for it 
a complete cyst. 

Experiment II — The right carotid artery of another dog was se- 
parated from its contiguous parts, on the 17th of May, and a lead 
wire placed around it, as in Experiment I. The lips of the wound 
were kept in contact with sutures and adhesive strips. I examined 
it three days after, and found that it had united by the first intention, 
in the whole of its course, except in those points included by the 
stitches; these I cut loose, and dressed it simply with adhesive strips. 
When I looked at this dog again, I found that from the itching of the 
wound, the animal had scratched off the dressings, and broken up 
the new adhesions; I washed it carefully to remove the dirt, and 
dressed it with simple dressings. It healed kindly, and was entirely 
well on the 6th of June, at which time I killed the dog, and made a 
careful dissection of the parts. The cellular substance here was much 
thickened and indurated, forming a strong bond of union between the 
nerve, vein, and artery. The two former were in their natural con- 
dition; the artery was pervious its whole extent, to within three- 



20 Levert on Metallic Ligatures applied to Arteries. 

eighths of an inch of the wire: at this place the calibre was entirely 
obliterated; a firm substance, resembling bruised muscle, filled its 
cavity; between the ligature and the head, the artery was impervious, 
and much diminished in size, having the appearance of a mere cord, 
not exceeding one-fourth the original dimensions of the vessel. The 
lead preserved its situation around the artery; it had become entirely 
encysted, and not the slightest remains of inflammation existed. 

Experiment III. — I cut down on the left carotid of a third dog, on 
the 29th of May, and proceeded as in Experiments I. and II. differ- 
ing in no respect, except in dressing the wound: I used no stitches, 
but merely adhesive plasters. 

June 1st. — I examined the wound, and found that it had united 
through its whole extent, but as I supposed the union not to be very 
firm, the strips were reapplied, and suffered to remain on until the 
5th, when they were removed altogether. 

June 2,7th. — The animal was killed and a minute examination 
made. The lead wire was found around the vessel, which was im- 
pervious for an inch or more, as in the former experiments. The sur- 
rounding parts healthy. 

Experiment IV. June 9th.-— The dog which was the subject of the 
last experiment, having entirely recovered from the first operation, 
now became the subject of a second, which was performed on the ca- 
rotid of the opposite side. This was conducted exactly as the pre- 
ceding; the wound united by the first intention without the least dif- 
ficulty; no constitutional symptoms manifested themselves. On the 
27th, at which time this dog was killed, an examination was likewise 
made of this side of the neck; the appearances corresponded exactly 
with those of the preceding experiments. 

Experiment V. Jlugust 5th. — I performed a similar experiment on 
the carotid of another dog. I killed him on the 3d of September, and 
found that the appearances differed in no respect from the foregoing. 

The lead having answered my expectations so well in these 
cases, I felt a great inclination to ascertain, whether that substance 
alone possessed the property of remaining in contact with the living 
tissues, without exciting irritation or any unpleasant consequences, or 
whether similar results might not be obtained by using the other me- 
tals. I accordingly continued the subject, using gold, silver, and pla- 
tinum, instead of lead. 

Experiment VI. Jlugust 12th. — The right carotid of a dog was se- 
parated neatly from its surrounding parts, and tied firmly with a 
small gold wire; the wound was kept closed with adhesive strips, and 
by the third day had united firmly. Sept. 2d. The dog was killed, 



Levert on Metallic Ligatures applied to Arteries. 21 

and I examined his neck; I could perceive no difference in the ap- 
pearances exhibited here, from those produced by the lead. 

Experiment VII. October 15th. — I exposed the left femoral artery 
of a dog, and placed around it a gold wire. 15th. I examined this 
dog, and found that from his restlessness he had removed the dress- 
ings and had torn open the wound; I replaced them, and he recovered in 
a short time. Oct. 30th. I examined the subject of this experiment, 
and found that the results corresponded in every particular with those 
above related. 

Experiment VIII. October 16th. — The above experiment was re- 
peated on this dog; the wound healed very kindly by the first inten- 
tion, &c. Oct. 30th. I found the result to coincide with the last in 
all particulars; there was a slight appearance of ecchymosis around 
this ligature, which, no doubt, would have been removed in a few 
days more, only fourteen days having elapsed between the operation 
and the examination of the result. 

Experiment IX. October 5th I passed around the carotid of a 

dog, a piece of silver wire, and united the wound by the first inten- 
tion, which had taken place on the 9th, at which time I examined it. 
Oct. 30th. I found that the silver had become encysted, and had left 
no remains of irritation. 

Experiment X. October 5th. — The same experiment on another 
dog. 30th. The results the same. 

Experiment XI. October 13th. — I passed a silver wire around the 
right femoral artery of a dog. 15th. Wound healed. 30th. Wire 
encysted. No traces of inflammation remaining. 

Experiment XII. August 29th. — I cut down on the left carotid of 
a dog, and passed around it a platinum wire. This animal made his 
escape, and I did not see him again until the 16th of October, when 
I examined his neck; the wound had united so nicely that its former 
situation could scarcely be recognise; the cellular substance beneath 
was slightly thickened and indurated; the artery was obliterated for 
an inch and a half or two inches; the middle portion resembled a 
small cord, around the centre of which, I found the platinum wire 
enclosed in a mass of condensed cellular substance, which formed for 
it a cyst; the inside of this cyst was smooth, and adhered closely to 
the platinum; no traces of inflammation remained. 

Experiment XIII. October 15th. — Another dog was subjected to 
an experiment resembling the above in all particulars. Oct. 30th. I 
killed him and found no other difference in the appearances, than 
that the cyst which enclosed the platinum, was not so perfectly form- 
ed; it however existed. 



22 Levert on Metallic Ligatures applied to Arteries. 

Experiment XIV. October 16th. — This experiment was conducted 
precisely as the two last; the appearances upon examination were 
the same. This dog was the subject of Experiment VII. and was 
examined on the 30th of October. 

Experiment XV. June 15th. — I enclosed the humeral artery of a 
dog in a ligature made of a single stran of silk, previously waxed. In 
applying the ligature, I drew it barely tight enough to place the op- 
posite sides of the vessel in contact, without dividing the internal and 
middle coats. Both ends were then cut off, and the lips of the wound 
placed in apposition; it did not unite, however, by the first intention, 
the dressings having been removed by the animal; it was now dress- 
ed in the usual way, and soon healed perfectly by granulations. On 
the fourteenth day after the operation, I made a dissection of the 
parts: the artery was filled with a firm coagulum, both above and be- 
low the place of the ligature, which prevented the possibility of hae- 
morrhage, so firmly did these coagula adhere to the parietes of the 
vessel. 

The ligature was found in the centre of a small abscess, loose and 
detached from the surrounding parts; the artery was ulcerated through, 
the ends being separated a short distance. 

Experiment XVI. August 15th. — I repeated this experiment on 
the femoral artery of another dog; the wound was united by the first 
intention. Sept. 2d. — Upon dissection, an abscess as large as a pea, 
was discovered immediately under the skin and above the artery; the 
loop of silk was found in its centre, and offered no resistance when I 
attempted to remove it. 

Experiment XVII. — I passed under the femoral artery of a dog a piece 
of gum elastic, previously stretched and rolled to render it of a proper 
size, and tied it with a single knot. This operation was performed on 
the 15th of August; the wound united by the first intention. Sept. 
3d. — An examination was made of the result of this experiment. The 
ligature was found encysted; the inner side of the cyst was uneven, 
and not in close contact with the gum elastic; from its appearance, I 
thought that pus had existed, but was now absorbed; the artery was 
obliterated to the next branch, both above and below. 

Experiment XVIII. August 20th. — The same experiment repeat- 
ed on the right carotid of another dog. 23d. — Perfectly united by 
the first intention. September 2d. — The gum elastic was found con- 
tained in an abscess as large as half a nutmeg; the artery was im- 
pervious both above and below the ligature, and ulcerated through at 
the place of its application. 

Experiment XIX. September 1st. — The experiment with gum elas- 



Wright's Reports of Cases of Erysipelas. 23 

tic was repeated on the femoral artery of another dog, and the wound 
united in the usual manner. This dog was the subject of Experiment 
XII.; consequently I had not an opportunity of examining him until 
the 16th of October, when he was again caught. The cicatrix in the skin 
was to be seen plainly. On making an incision at this place, I per- 
ceived a small lump, about the size of a pea, immediately under the 
skin, and at the lower angle of the wound. I opened this and found it 
to contain the gum elastic ligature, surrounded by a small quantity of 
yellowish-looking pus; the vessel was removed for the space of an 
inch and a half, both ends obliterated. Just above the place of the 
ligature, several small arteries, not distinguishable in the healthy 
condition of these parts, were observable, and appeared to be spent 
upon the contiguous muscles. 

Experiment XX. August 9,5th. — I cut down on the left femoral 
artery of a dog, and tied it firmly with a grass ligature, such as is 
used for fishing-lines. 9,7th. — It had healed by the first intention. 
September 9d. — The grass was found encysted, but the inner side of 
the cyst was moist and uneven, and did not appear to embrace the 
ligature closely; no appearance of inflammation. 

Experiment XXI. August 9,5th. — The same operation performed 
on another dog. September 3c?.— It was examined and found to cor- 
respond with the twentieth in every particular. 

From the experiments now detailed, we may, I think, conclude, 
that the plan of tying arteries with lead and the other metals, is free 
from danger, and may be productive of some peculiar advantages; 
more experience, and a greater number of experiments are necessary 
to establish this point thoroughly, and it is to be hoped that some one 
fully competent to the task? will prosecute the subject. 



Art. II. Reports of Cases of Erysipelas, treated at the Baltimore 
Alms-house Infirmary, showing the countervailing influence of that 
disease over other affections existing in the system at the time of 
its invasion, with Observations. By Thomas H. Wright, M. D. 
Physician to the Institution. 

Jb ROM some cause, not satisfactorily definable, Erysipelas, in various 
forms, has for fifteen months prevailed among the patients of the Bal- 
timore Alms-house. During this period, the disease has never been 
wholly absent, but the cases have been commonly single, and never 



24 Wright's Reports of Cases of Erysipelas. 

more than two or three in number at the same time; usually about the 
close of the disease in any one case, a new instance of it, in the forming 
state, has been presented in some other patient. There has, how- 
ever, been no very significant reason to suppose that the disease 
was propagated by contagion. The cases which succeeded each 
other have occurred generally in patients who had no vicinity to, 
or intercourse with each other; the individuals attacked in succes- 
sion being commonly confined to bed remotely from one another, 
often in different and distant wards. There has been but one in- 
stance of two patients having stations near each other being succes- 
sively affected. 

The disease in question has been apparently as independent of any 
appreciable general causes of production as of special propagation, 
it having existed in the house for a period embracing all the revolu- 
tions of season, and remaining unmodified. 

There has been a marked uniformity of symptoms in a great ma- 
jority of the cases of the disorder, the general character of which, 
together with some of its curious and not uninteresting results, it is 
the design of this paper to report. With rare exceptions, the dis- 
ease presented constantly a blended form of the cedematose and 
vesicular species. Of a large number of cases, a few only exhi- 
bited the phlegmonoid character, terminating in suppuration. With 
similar infrequency of exception, the disease occupied the same seat. 
It commenced in almost every instance on the forehead, spread ra- 
pidly over the scalp and face, and defined its bounds in front at the 
meeting of the submaxillary integument with that of the neck; some- 
times extending behind also, as low as the sub-occipital margin. Only 
a few cases of the vesicular form invaded any other seat than the face 
and scalp, and of these one or two appeared on the trunk and limbs, 
the breast, arm, or leg. Thus there were a few cases of the phlegmo- 
noid species, and one or two of the simply oedematose form, (with 
one case of the gangrenous or sphaceloid character, ) occupying va- 
rious seats, as the arm and forearm, the thigh and leg. All the rest 
of the cases were eminently vesicular. 

It is not the design of this report to bring into discussion the ge- 
neral pathology or treatment of erysipelas, though there are few 
forms of disease of more serious character than erysipelas of the face 
and head, associated as it commonly is, with very decided constitu- 
tional impression. The pathological and curative indications of erysi- 
pelas have been themes fruitful of opposite opinions and practice; and 
it is yet much controverted whether the various forms of that affec- 



Wright's Reports of Cases of Erysipelas. 25 

tion shall be classed among diseases of high or of low excitement, 
and of course, whether the treatment shall be conducted on the an- 
tiphlogistic or cordial plan. Much of the discrepancy of opinion in 
this respect seems to have arisen from a partial view of the subject, 
or the consideration of the disease under the very different aspect it 
presents, in different stages of its progress. The constitutional dis- 
turbance attending erysipelas is peculiarly prone to sudden and great 
mutation. Like other febrile states of the irritative class, but in a 
greater degree than almost any other, the phenomena of erysipelas, 
both local and general, exhibit a very different aspect, and actually 
represent a very different state of the system, in a brief interval of 
time. The tumult of the vascular function which attends the forming 
stage of erysipelas, often mounts as the local expression of the dis- 
ease is thrown out, to a very explicit entonic grade of excitement, as 
is unequivocally manifested by both the local and constitutional signs. 
But that excitement, after an uncertain duration, generally a short 
one, commonly runs rapidly toward the point of collapse and ex- 
haustion. The disease then, viewed under its different aspect in 
distinct stages of its course, must wear a character correspondent to 
its time of duration and sum of effects. Hence, perhaps, the main 
cause of adversary hypothesis as to the essential character and appro- 
priate treatment of erysipelas. And while this consideration may 
serve to reconcile seemingly conflicting opinions on the nature and 
attributes of the disease, it inculcates the necessity for vigilant dis- 
crimination in adapting the treatment, both local and constitutional, 
to the altered circumstances of the system and the part.* 

The following cases are reported with the design of pointing out 
the very manifest controlling or modifying influence displayed by 
erysipelas, over other forms of disease existing in the system at the 
time of its invasion. 

Case I.— Hannah Kennard, forty -five years of age, full habit and 
firm constitution, was admitted into the Baltimore Alms-house, 
June 7th, 1827, for treatment of a large inveterate ulcer of the 

* The above general remarks on the character and tendency of erysipelas, 
refer chiefly to erysipelas of the face and head, with explicit constitutional 
disturbance; a form of disease generally and justly considered of very se- 
rious import. It may be noticed here, what is sufficiently obvious, that 
the character and tendency of every form of erysipelas will be modified 
and determined by the causes which give occasion to its occurrence, and by 
the constitutional or casual state of the system at the time of its develop- 
ment. 

No. VII. —May, 1829. 4 



26 Wright's Reports of Cases of Erysipelas. 

leg, of four years standing. Her general health was unbroken. Oil 
the third day after admission, this woman complained in the evening 
of being sick, feeling alternately chilly and feverous, with head-ache 
and nausea. Ordered an emetic, to be followed by a full dose of 
calomel. 

The following morning, the second of the disease, there was sore- 
ness, with swelling, heat, and inflammatory blush, over the integu- 
ment of the forehead, face, and part of the scalp, the swelling greatest 
on the forehead. The pulse was frequent and full, febrile heat gene- 
rally diffused over the body, tongue white, head painful. The woman 
attributed her indisposition, (incorrectly I think,) to having been 
washed in cold water, when first admitted into the house. This was 
the first instance of erysipelas of the face and scalp occurring in the 
house, after the medical department of the institution had been placed 
in my charge. She was ordered small doses of calomel, nitre, and 
antimonial powder, at intervals of four hours, with an intervening 
dose of weak solution of tartar emetic, charged with spirit of nitre; 
drink, barley water acidulated ; diet, milk diluted, and toasted bread; 
free admission of air. The local affection was treated with solution 
of muriate of ammonia in distilled vinegar and water; the solution 
charged with a small quantity of tincture of camphor, and applied 
cool, by means of linen cloths. 

On the third morning the face and scalp were swelled to great de- 
formity; the palpebrae loaded and closed, the cheeks almost level 
with the spine of the nose, lips very thick and hard, the whole sur- 
face, forehead and face, smooth and glistening from tension. The 
pulse more frequent than on the day before, still full but less firm; 
the general heat increased, tongue brown, with white edges, and 
moist; head painful, mind somewhat unsteady. The medicine was 
continued, with addition of camphor to the powders of calomel and 
nitre; and, on account of slow bowels, sulphate of magnesia was 
added to the draught. The local application was also continued, but 
under an impression that it would be more soothing, and better re- 
lieve heat and tension, it was directed to be used pleasantly warm. 
Afternoon, large and very much elevated vesications over the face, 
and which were directed to be carefully punctured, the effused fluid 
gently washed off with tepid water, and the warm ammonia lotion 
reapplied; on account of vigilance and restlessness, a full anodyne 
of Dover's powder was ordered for the night, after operation on the 
bowels. 

Fourth morning, the patient was a good deal prostrate, pulse con- 



Wright's Reports of Cases of Erysipelas. 27 

tracted and quick, surface rather cool, tongue dry, and brownish- 
red, bowels lax, the face and scalp less swoln, surface of vesications 
dry and red 5 the patient was quieter than before, and rather dis- 
posed to somnolency, approaching stupor. The treatment was now 
changed. Quinine was ordered, one grain in two hours, dissolved in 
acidulated aromatic water, with tincture of bark, spt. mindereri 
every four hours, with ten drops of laudanum, to restrain the bowels; 
local application continued as an occasional wash for the erysipelatous 
surface, which was after dusted with common starch. Diet rendered 
somewhat cordial, by a small addition of wine to the bread tea, which 
had been previously used in a simple state. 

Fifth day, the energies of the system had rallied sensibly, irrita- 
tion of the bowels allayed, pulse less frequent, and more steady, 
the surface naturally warm, and the patient acknowledged improve- 
ment of feelings. The amendment continued. On the sixth day fever 
was absent, the patient sat up in bed, and took nourishment with 
sufficient appetite. Her complete recovery was established in a few 
days; the whole erysipelatous surface desquamated. 

The ulcer of the leg, five or six inches every way in surface, which 
had remained in a foul, unhealthy condition for four years, in a few 
days after the fever of erysipelas subsided, filled up rapidly with 
granulations of good size and colour, and, under simple treatment, 
with rest, closed in with a firm, smooth surface, in little more than a 
fortnight after recovery from her late illness. 

Case II. — William Ivy, aged twenty-six, robust constitution, was 
admitted into the Baltimore Alms-house October 12th, 1827, labour- 
ing under very severe inflammatory rheumatism of nearly a fortnight's 
duration. Active inflammation, with great swelling, occupied the 
carpal articulation of both wrists, and extended over the fascia of 
both arms and hands; the tension of the inflamed parts was unusually 
great, the local sensibility and distress extreme; there existed high 
feverous tumult, much heat, thirst, &c. The case seemed one of 
simple rheumatic feverous irritation, confined mainly to the vascular 
system; none of the important organs of either the great cavities ap- 
peared to suffer any particular degree of embarrassment. 

The treatment in this case was conducted on the plain indication 
of restraining excitement, and quieting irritation from pain. Vene- 
section, moderate purging, diaphoretics of the sedative, non- stimu- 
lating class, and anodynes at intervals, constituted the general means. 
The chief local application was first the cold lotion of muriate of 
ammonia with tinturc of camphor, afterwards the same as a warm 



28 Wright's Reports of Cases of Erysipelas. 

embrocation, the former temperature seeming constantly to increase, 
and the latter to allay somewhat the pain and sense of tension. 

This patient was bled as often and freely as seemed at all neces- 
sary or prudent, was kept with uniformly soluble bowels, took nitrate 
of potash with antimonial powder, or ipecacuanha, or tartar emetic, 
(occasionally the colchicum,) in as full doses as the stomach would 
bear, sometimes the same medicines in combination with opium, or 
hyosciamus, used the warm bath at suitable intervals, was at last ful- 
ly salivated by calomel in small doses, employed in combination with 
other agents as a diaphoretic; yet for twenty-one days the pain and 
distress scarcely relaxed, even partially; neither did the fever in all 
that time intermit, nor sensibly abate.* 

About this stage of the case, Ivy was seized, without any evident 
cause, with a very distinct rigour, or chill. His body became cold; 
skin dry and pale; pulse small, weak, and frequent. This state lasted 
more than an hour, when, by cordial drink and warm applications, 
reaction was established. As this took place fever returned, but the 
character of excitement was a good deal changed. The pulse was 
now less full, the heat of surface not so great, the head more painful 
and confused, with more of general torpor, and the whole system, in 
short, was more prostrate than before. 

During the following night the patient was, for the first time since 
he came under treatment, unsteady in mind, muttering, or speaking 
unconsciously; and when aroused, complained much of his head. The 
next morning, the face and scalp were observed to be swelled, the 
former exhibiting an inflammatory blush, with a shining or polished 
appearance, and some degree of effusion in the cellular tissue around 
the eyes. This was the man's state at my visit about ten o'clock, and 
it was now plain that erysipelas had supervened. 

It immediately occurred to me as probable, and such impression 
was mentioned to my assistants, that the intruding disease might ex- 
tinguish the rheumatic action, both local and general, which we had 
hitherto found so intractable and persisting. At the same time it was 
manifest that danger, perhaps greater than before, now existed. 

* Free perspiration, generally considered so desirable and salutary in fever 
of acute rheumatism, was early produced in Ivy's case, and the skin continued 
uniformly in full action during nearly the whole course of treatment; yet, so 
retentive of excitement had the vascular system become, that neither the fre- 
quency nor volume of the pulse, nor the evolution of febrile heat, were per- 
ceptibly restrained or abated, by universal diaphoresis fully maintained for a 
long period. 



Wright's Reports of Cases of Erysipelas. 29 

In thirty-six hours from the onset of this form of disorder, the whole 
scalp was swelled and very tender; the face was expanded and tense 
to great distortion; the eyes closed and encumbered by excessive in- 
filtration of the lids, the lips thick and rigid, from a similar cause; 
vesications, at the same time, overspread the middle region of the 
face. The general circumstances of the patient were frequent, small, 
irritable pulse; red tongue with clammy surface, and rather dry; sur- 
face of the body temperate, without sensible moisture; head affected 
by dull pain; belly somewhat full and tender; aversion to food; posi- 
tion supine; manner torpid and listless. 

The treatment of the case was simple. The medicinal agents were 
chiefly the subcarbonate of ammonia, (in the form of spt. mindereri,) 
to which wine of ipecacuanha was added, and occasionally five drops 
of laudanum, to restrain a tendency to diarrhoea, which occurred with 
the inceptive symptoms of erysipelas. With this course was direct- 
ed immersion of the extremities in warm salted water, at intervals, 
and warm spirituous fomentations every few hours to the abdomen. 
The patient's drink was cool barley water, with sugar and acid; his 
diet, milk diluted, with toasted bread macerated in the sauce. The 
local inflammation was treated by fomentation, with solution of mur. 
ammoniae, containing tinct. of camphor. 

This patient was convalescent on the sixth day from the chill, and 
it may be said, that not a vestige of rheumatic irritation, either local 
or general, was apparent after erysipelas made its incursion. The 
inflammation, swelling, and pain of the carpal articulations, which 
had remained undiminished up to the time of the occurrence in ques- 
tion, subsided remarkably, even during the course of the superadded 
disease, and no reference was made by .the patient to pain of those 
parts, after commencement of inflammation, swelling, &c. from ery- 
sipelas, about the head and face. The, character of fever, as proper 
to acute rheumatism, was at the same iim^* extinguished, and did not 
in any degree recur. In fact, after the general disorder concomitant 
of erysipelas passed away, which it did very rapidly, Ivy remained 
wholly free of fever, and gradually recovered his full stock of health. 
The carpal articulations continued very weak for some time after his 
general health was restored. 

Case III. — William Pine, aged about thirty, had been for many 
months in one of the cells of the Baltimore Alms-house, in a state of 
insanity. From what could be learned of his history prior to admis- 
sion, he had been for some years in an unsettled state of mind, and 
had occasionally undergone medical treatment and moral restraint 
on that account. His understanding, at the time of his admission, 



30 Wright's Reports of Cases of Erysipelas. 

seemed wholly obliterated, and he continued without after-evidence 
or interval of reason, during the time stated; namely, for many 
months. His manner was generally silent and sullen, and when he 
could be excited to any degree of effort, he spoke with rapid incohe- 
rence, his conversation running into a chaos of folly. The man's bo- 
dily health seemed little affected by his state of mind; he became 
somewhat emaciated from confinement, but his pulse was always calm 
and equal, and the temperature of body natural. He took food re- 
gularly, though without that voracity of appetite frequently attend- 
ing insanity, and the excretions necessary to health were sufficiently 
performed. In respect to the latter, however, the patient had revert- 
ed to the state of childhood; the evacuations were passed without re- 
gard to time or circumstances. 

The preceding statement is given to show the man's common state 
while in the house. On the 9th of June, Pine was attacked by chill, 
with high fever, flushed countenance, inflamed eyes, foul tongue, and 
the general evidences of great disorder. He was immediately remov- 
ed from his cell to the infirmary, for the benefit of a purer and fresher 
atmosphere. On the day succeeding the chill, a deep florid hue over- 
spread the face and scalp, swelling went on rapidly, attended by the 
smooth, glistening appearance characteristic of erysipelas, with effu- 
sion into the cellular structure of the eyelids, lips, &c. as described 
in the former cases. The feverous tumult was much more marked, 
than in the preceding instances, with severe head-ache, great heat of 
body, &c. 

Already, in the first stage of this acute attack, Pine's intellect 
seemed to be rousing from its long torpor and habitual error. When 
questions were addressed to him now, there was an apparent act of 
deliberation before answering, and his replies, with occasional vacil- 
lation, were coherent and satisfactory. This relative saneness be- 
came more distinct and established as the disease advanced, and on 
the third, fourth, and following days of its course, Pine's manner, 
replies, &c. were orderly and rational; no longer betraying any ten- 
dency to alienation. The local inflammation, and constitutional dis- 
order were very severe in this case, for some days. The former re- 
sulted in early and extensive vesication, terminating ultimately in ge- 
neral desquamation of the cuticle of the face. The fever remitted on 
the fourth day, and subsided altogether about the sixth, (its nearly 
uniform period of cessation in almost all the cases,) leaving the pa~ 
tient much debilitated. 

The treatment was conducted by moderate purging with calomel, 
followed by Epsom salts, with minute addition of tartrite of anti- 



Wright's Reports of Cases of Erysipelas. 31 

mony. The subcarbonate of potash, with wine of antimony or ipecacu- 
anha, was afterwards given generally through the course of fever, in 
doses and at intervals regulated by its effect on the stomach, pulse, 
and skin. The patient's drink, diet, and general regimen was the 
same as in the cases before reported, and the local application used 
in the other cases, was employed in this also.* 

The intelligence which had been revived in Pine's case, with the de- 
velopment of erysipelas, continued during his convalescence, and he 
left the institution without having betrayed indications of lapsing 
into former obliquity of mind. This man abused the privilege grant- 
ed to convalescents, of walking in the yard for air and exercise, and 
eloped from the alms-house, ten days after recovery from erysipelas. 
His state since then is not known to me. 

Case IV. — Kitty Day, aged twenty-eight, had entered the Baltimore 
Alms-house, in April, 1827, with blended symptoms of rheumatism, 
and secondary syphilis. Periostitis was developed in various seats, more 
particularly on the frontal and parietal bones. After a long course 
of alterative treatment, chiefly by purgatives and the compound de- 
coction of sarsaparilla, with regulated diet, her general health was 
very much amended, the points of periosteal disease faded away for a 
time, and she engaged in some of the labour of the house. An im- 
pression made by cold, from her taking part in scouring the hospi- 
tals, renewed the inflammation with great intensity, in its original 
seat on the right parietal bone. The local affection ran on to suppu- 
ration, with extensive detachment of the scalp, and, ultimately, ne- 
crosis of the external table of the skull ensued. The surface of dead 
and denuded bone was from one to two inches in diameter, and was 
penetrated in many points from loss of substance, presenting a cel- 
lulous or honey-comb series of cavities, admitting the probe down to 
the medullary portion of the cranium. The integument also exhibit- 
ing a similar series of openings, from which a foul discharge was con- 
stantly exuding. The patient was much distressed by remittent he- 
micrania. 

While under treatment for this renewed and aggravated state of 

* I regretted afterwards not having used the lancet guardedly in Pine's case. 
I think it would have been well borne, and beneficial, and it would have been 
satisfactory to test cautiously the effects of venesection in such cases. Pine's 
was the only instance in a number of cases, where the excitement seemed to 
justify experiment by direct depletion, and in his case it was omitted, partly 
because all the others had done well without it, but more from the considera- 
tion, that the inroad of erysipelas had found his system a good deal subdued by 
a long course of solitary confinement. 



32 Wright's Reports of Cases of Erysipelas. 

her original symptoms, Day became suddenly ill, and as her illness 
was ushered in by chill and fever, acute pain of the head, and swell- 
ing over the scalp, particularly around the portion of diseased bone, 
with low delirium and early stupor, the pupils of the house conclud- 
ed that the new train of symptoms arose from inflammatory irritation 
in the investing membrane of the brain, lighted up in connexion with 
the renewed local disease of the skull and scalp. This was the re- 
port of Day's case, at my visit on the morning following her acute at- 
tack. On examining the patient, I thought the symptoms referrible 
to the stage of erysipelas. The tumefaction, considerable all over 
the head, had extended to the face, which was florid, tense, and glis- 
tening. Those characters of the local affection, particularly the ex- 
tent of surface involved, led me to decide that its nature was erysi- 
pelatous, rather than a state symptomatic of meningitis, derived from 
disease of the cranium and scalp. The state of stupor to so great a 
degree, though not a very common attendant on erysipelas of the 
head and face, and not associated with that disease in any former 
case occurring in the house, might very possibly be connected with 
such affection, suddenly developed in that seat with unusual intensity. 

The explicit signs of erysipelas were soon manifested, and they 
assumed a severity not observed before. It traversed the whole su- 
perficies of the face, passing below the facial line of the inferior jaw, 
and terminating abruptly in front at the line of meeting between the 
skin of the face and that of the neck. Under the jaw the inflamma- 
tion was propagated to the cellular tissue, producing swelling, thick- 
ening, and pain, and very much impeding swallowing. The inflam- 
mation on the face, in the present instance, passed its common limits, 
in other respects, also overspreading the ears, rendering them tumid 
to a great degree, and penetrated down the meatus externus, proba- 
bly to the tympanum, as the sense of hearing was abolished for some 
time. The mucous membrane of the palpebral, and the conjunctival 
tunic of the eyes, were also invaded; intense inflammation occupied 
the latter seat, terminating in ulceration of the cornea of the left 
eye. 

This case ultimately ended well. After many days of febrile dis- 
order of the low, irritative kind, with delirium, attended by exces- 
sive tumefaction of the scalp and face, blindness, deafness, and great 
discharge from the ears, the constitutional disturbance and local af- 
fection gradually subsided, and the patient slowly regained her 
health, hearing, and vision, except a slight opacity of the cornea of 
the left eye. 

The remarkable effect of erysipelatous development in this case is 



Wright's Reports of Cases of Erysipelas. 33 

the fact, that on the recession of inflammation, swelling, &c. of the 
scalp, it was found, that all the ulceration and the fistulous openings 
in the scalp over the extensive surface of caries of the parietal bone, 
were completely shut up and consolidated, the integument apparently 
adhering firmly to the bone over the seat of caries, and dipping down 
into the cavities caused by waste of substance in portions of the outer 
table of the skullj three or four indentations capable of receiving the 
point of the finger, now exist in the former seats of fistulous ulcera- 
tion. There is no appearance of inflammation about the points in 
question, nor is the scalp more sensitive there than in other regions 
over the head. 

Case V.— Kitty Newman, aged thirty-six, entered the Baltimore 
Alms-house, June, 1828, on account of porrigo favosa of the scalp, at- 
tended with large pustules, which overspread nearly the whole face, 
but in patches of three or four together, with margins touching each 
other, and somewhat blended. These pustules were a good deal elevat- 
ed on a dark red indurated base, with summits encrusted by dry scabs, 
occasionally desquamating, and again renewed. The porriginous dis- 
ease of the scalp, and the pustular affection of the face, were probably 
the same in nature, but an apparent distinction seemed to be established 
by the fact, that the latter was wholly without that constantly distilling 
ichor so characteristic of the severer forms of porrigo, whether seated 
on the head, trunk, or limbs. Both those states of eruption had ex- 
isted four years prior to the woman's admission into the Alms-house; 
the pustular disease of the face preceding the scald head many 
months. The patient reported herself to have undergone repeated 
salivation, and other alterative treatment — local and general — with- 
out benefit. 

This woman became the subject of erysipelas a few weeks after 
entering the Alms-house Infirmary. The disease put on the same 
aspect, occupying the same seat, as in the preceding case. The in- 
tensity of constitutional impression, however, was less 5 there being 
in this case neither stupor nor delirium. The swelling of the face 
and head, sense of tension, burning heat, &c. were very great, pro- 
ceeding to early and extensive vesiculation; and, as in Day's case, 
the ears were exceedingly tumid and painful, and hearing for a time 
extinct. The inflammation involved here also, the integument and 
cellular substance under the lower jaw, causing much enlargement 
at that point, and impeding speech and swallowing. The eyes escaped 
inflammation, though shut up by tumefaction of the lids. 

The fever was comparatively mild, and did not tend to that low 
irritative character which had accompanied most of the former in- 

No. VII.— May, 1829. 5 



34 Wright's Reports of Cases of Erysipelas. 

stances of the disease. Moderate purging by mild neutral laxatives, 
cool acidulated drink, light farinaceous food, and fresh air, with rest, 
were sufficient to conduct the case to a safe result. The local treat- 
ment was the same as in other cases, with a constant covering of 
starch powder toward recession of the inflammation, and during se- 
paration of the cuticle. The sub-maxillary integument and cellular 
tissue remained swelled and indurated for a fortnight after disap- 
pearance of erysipelas from the face, and finally the indolent enlarge- 
ment suppurated opposite the mastoid process of the left side, and 
was discharged by incision. 

It was pleasing to contrast the appearance of this woman's face, 
after the erysipelas had passed off, with the character it had exhibited 
previous to the incursion of that disorder. Not a vestige of the hideous 
crop of scabrous pustules, with which the face was before deformed, 
now remained. The surface was perfectly smooth, and only a shade 
of rather more colour than the natural hue of skin, pointed out the 
former seat of foul eruption. The porriginous disease of the scalp 
was almost as much corrected, something of the furfuraceous condi- 
tion of the skin of the head exists, but infinitely less offensive than 
its former filthy state. 

Case VI. — Elizabeth Fowler, aged sixty-four. This was a chronic 
case, (long in the Alms-house,) of general disability, complicated 
with Paralysis agiians. The case was very strongly marked by total 
loss of control over the whole set of muscles of voluntary motion, and 
the substitution of an involuntary, incessant, tremulous, and vacillat- 
ing action of those muscles. This was so much the case that the 
unfortunate subject of the disorder could not suppress the agitation 
of the head and limbs for a moment, nor convey food or drink to her 
lips. 

Elizabeth Fowler suffered an attack of erysipelas about the ter- 
mination of the preceding case. No instance of the disorder occur- 
ring in the house exhibited a more full expression of the local inflam- 
matory symptoms, than was displayed in the case of this infirm old 
woman. Besides its ordinary extent of swelling, pain, &c. over the 
whole face and scalp, the inflammation assumed a more acute and 
penetrating character, in some respects, in the present, than in any 
former instance. As in the case of Day and Newman, the parts be- 
low the jaw became very much swoln and indurated, but the pain of 
that part, and the difficulty of swallowing, were far greater in Fow- 
ler's case than in either of the others; insomuch, that for many days 
scarcely drops of fluid could be forced into the stomach. The 
tonsils were so enlarged as to touch each other, and all the 



Wright's Reports of Cases of Erysipelas. 35 

* 
parts around the top of the oesophagus — the funnel of the pha- 
rynx — exhibited a deep inflammatory colour, as did also the 
tongue, the floor of the mouth, and the fauces generally. The state 
of the throat and mouth, in short, was the same as in severe quinsy, 
and would have been attributed to a casual complication of cynanche 
with erysipelas, had there not appeared a marked connexion and de- 
pendance of the inflammation of the fauces, with, and upon, the ex- 
ternal development of erysipelas. The commencement, course, and 
close of the symptoms, showed their intimate relation, and a similar 
state of the throat and fauces, in a minor degree, attended other 
cases of erysipelas occurring in the house. 

The constitutional symptoms were urgent in the degree to be in- 
ferred from the nature of the disease, and the character of the local 
affection. Fever of irritation was exquisitely marked; small, rapid 
pulse; pungent heat of surface, universal and unabating; great thirst; 
dark red tongue, soon becoming dry and fissured. Among the dis- 
orders of the gastric ceconomy, were loathing of food, and retchings 
to vomit, with tenderness of the epigastrium and abdomen, and tym- 
panitic fullness of the latter region; bowels costive. From the onset 
of the disease the sensorial functions were much disturbed, with vigi- 
lance, anxiety, restlessness, and vehement complaint; symptoms 
passing on to frequent fits of fugitive delirium. 

The medicinal treatment in this case was unusually limited and 
simple, owing in part to resistance, sometimes voluntary, sometimes 
unconscious, of the patient, against the use of medicine, and in part 
to her great difficulty of swallowing even small quantities of liquid. 
Some purgative effect was occasionally accomplished by medicine, 
but chiefly by injections; otherwise the treatment rested mainly on 
cool acidulated drink, as much as could be taken, fresh air, and 
ablution (with sub-tepid water) of the extremities, frequently re- 
peated; fomentation of the abdomen was also employed, on account 
of fulness and tenderness of that region. This was the course of ma- 
nagement during the more acute stage of the disease, for the first 
four or five days. Afterwards, when fever fell to a subacute type, and 
the difficulty of swallowing became less, the patient took somewhat 
regularly a neutral febrifuge preparation, chiefly the spt. mindereri 
with spt. nitre, and on farther decline of the excitement, with a 
tendency to prostration, the quinine was exhibited freely, and cor- 
dial nourishment allowed in as full amount as could be taken. The 
treatment of the local affection was the same as in all the preceding 
cases; namely, by the camphorated ammonia lotion, warm, with an 
acidulous wash for the fauces and throat., 



36 Wright's Reports of Cases of Erysipelas. 


The patient, very contrary to my apprehension at its commence- 
ment, struggled through her formidable disease. Her convalescence 
was slow, but all constitutional disorder at last passed off", and re- 
pair of strength gradually took place. Even yet, however, five weeks 
posterior to the termination of the general disease, tumour, thicken- 
ing, tenderness, and tendency to chronic suppuration, remain under 
the lower jaw. 

One effect of the erysipelatous incursion in this case, was curious 
and interesting. Almost as soon as the inflammation of erysipelas 
began to overspread the face, the agitation of her head and limbs was 
much abated, and on the second day of her illness, scarcely a slight 
tremor was obvious in any part of the body. When the patient was 
raised up in bed and supported, the head was now nearly still, and 
she could take a vessel containing drink in her hand, and carry it to 
her mouth with almost perfect steadiness. This state of comparative 
freedom from former involuntary movements, continued through the 
more acute period of the disorder. As the constitutional impression 
made by the erysipelas began to wear off, (about the ninth day,) there 
was a manifest tendency in the muscular system, toward its former 
habit of disordered action. The tremulous vibration of the head and 
hands became again apparent, chiefly on the patient's making exer- 
tion to talk or move; but the agitation of the head and limbs was not 
nearly so great as formerly, and has not sensibly increased during 
the patient's advancing convalescence. At the expiration of six or 
seven weeks after erysipelas and its train of symptoms have passed 
off, the patient is herself sensible, and all about her remark, that she 
is much less shaken and disabled, than before her late illness. 

I have thus reported, as succinctly as I could, a few cases, tend- 
ing to show what I have termed " the countervailing" or modifying 
influence of erysipelas, over other modes of disease with which it 
may happen to come in conflict. Many other cases occurring in the 
alms-house, have served to illustrate its effects in a similar way, often 
in a very obvious degree. But the subject is not, perhaps, of suffi- 
cient interest to demand multiplication of such reports, the facts they 
are calculated to establish being probably more curious than import- 
ant. Only one case of erysipelas, among those occurring in the house 
within the period mentioned, fifteen months, has proved fatal. This 
was the case of a black woman, who had suffered a severe attack, af- 
fecting the face and scalp, and recovered. Shortly after the disease 
was renewed in consequence of exposure at night to cool, damp air, 
from an open window. This relapse was attended by peculiar symp- 
toms; a chill occurred in the night; next morning, the right half of 



Wright's Reports of Cases of Erysipelas. ' 37 

the face and scalp were greatly swelled, tense and glistening, and 
the patient comatose. The right eye was singularly affected. It was 
so much protruded as to seem nearly out of the socket, and was itself 
so enlarged and tumid, as to appear likely to burst. The soft parts 
behind the globe were equally gorged by infiltration, as the lids were 
pressed forward with great tension and volume, and the conjunctiva 
affected with chemosis. As soon as I saw this patient, the conjunc- 
tiva was deeply and freely scarified, and, as well to take off inflam- 
matory irritation from tension, as to preserve the eye from apparent 
imminent hazard of giving way by rapid ulceration, the cornea was 
opened by incision near its sclerotic margin. The parts about the eye 
were thus sensibly relieved from extreme distention, and at the same 
time such general measures were directed as were deemed appropri- 
ate, chiefly blisters and cordial medicine, as the system was cold and 
torpid, and the vital functions seemed tending to sudden and fatal 
collapse. But the patient sunk continually, and died the night ensu- 
ing the attack, the whole course of the disease occupying little more 
than twenty-four hours. On dissection, abundant sero-sanious infil- 
tration was discovered in the medullary substance of the right ante- 
rior lobe of the cerebrum, as well as upon the pia mater in front of 
the right lobe, and about the neurilema of the right optic trunk. The 
subject of this case had been long in the Alms-house Infirmary, on ac- 
count of amaurosis, and presented also an instance of schirro-hydro- 
pic ovarian tumour, of great size, 

I have thought it not out of place, to subjoin to the forgoing report 
of cases a few remarks; first, on a part of the subject already touch- 
ed on in the introduction to the report; and secondly, on some 
points of difference among eminent authorities, as to the legitimate 
character, definition, &c. of erysipelas, and its varieties. 

Throughout the course of this disease among the patients of the 
Alms-house, great difficulty has frequently occurred to my mind, in 
arriving at any satisfactory idea of its manner of origin and propaga- 
tion. For a considerable time previous to the commencement of its 
late prevalence, there had been no instance of this disorder in the 
house, and the first case that fell under notice, occurred out of the 
house, and was brought into the institution. The circumstances, how- 
ever, wholly exclude the idea of propagation from this case. The 
man who was the subject of it, was placed in the surgical ward among 
thirty or forty other patients, not one of whom exhibited a case of 
erysipelas, for months after the man in question was discharged, 
and the case which followed this was Hannah Kennard, first 



38 Wright's Reports of Cases of Erysipelas. 

case reported, in the infirmary for female blacks, attic story of 
the building. The succeeding instance occurred in the infirmary 
for white males, in the east wing of the house, and the next appear- 
ed, not in the same hospital, but in a patient long confined in the sur- 
gical wards, the two patients having never seen each other. One of 
the most severe cases displayed itself in William Pine, long in soli- 
tary confinement in one of the cells, for mania, who was visited by 
none others than his medical attendants and keeper. 

It is unnecessary to pursue this question farther, as it is not de- 
signed to controvert the position, that some forms of erysipelas, 
(those only perhaps which possess, or seem to possess, the character 
of idiopathic affections,) maybe communicable under circumstances 
favouring such mode of propagation. The only countenance given to 
the opinion of probable contagion, during the late course of erysipe- 
las through the Baltimore Alms-house, was furnished by the succes- 
sion from the case of Kitty Day. Kitty Newman lay within one bed 
of Day, and Newman was attacked by erysipelas when Day was get- 
ting well. Elizabeth Fowler again, occupied a bed opposite to, and 
within a few feet of Kitty Newman, and Fowler suffered a severe at- 
tack before the close of Newman's case. Here the propagation, with 
vicinity of persons ceased. The next case that occurred in the same 
hospital, was in a woman named Long, who was out of the hospital, 
(as a convalescent,) great part of every day, yet slept there at night, 
but then used a bed in a part of the ward remote from either of the 
before-named women. The disease has not occurred in any of the 
male or female nurses. 

When I looked for the occasion of the prevalent disorder among 
the more common causes of disease, as cold for instance, either 
suppressing perspiration, or acting on certain predisposition in indi- 
vidual instances, circumstances would by no means generally war- 
rant a reference to it alone, as exciting the disease. In one or two 
cases, and only in those, the persons affected by erysipelas had been 
exposed just before the attack to a current of cool, damp, night 
air; in far the greater number, however, the disease occurred in 
patients in more sheltered situations than others who escaped. An 
examination of other possible causes of predisposition or excitement 
to the disease, furnished no satisfactory elucidation of its frequent 
occurrence in the institution. The food of the alms-house is always 
abundant, sound, and good, and is frequently changed; the diet of 
the hospitals especially, (among the tenants of which the disease al- 
most uniformly occurred,) is wholly at the discretion of the medical 
attendants. In relation to any question on the possible agency of a 



Wright's Reports of Cases of Erysipelas. 39 

hospital atmosphere in the evolution of the disease, all such presump- 
tion seems fairly set aside by the excellent police of the house. Per- 
sonal and general cleanliness, free and uniform ventilation, with im- 
munity from all sensible nuisance, are so characteristic of the institu- 
tion in all its departments, the hospitals not less than others, as to 
have been long and deservedly the admiration of all visitors.* 

Erysipelas, as well as some other forms of disease not possessing 
the attributes proper to epidemics generally, is yet supposed by re- 
spectable writers, to have been occasionally produced and diffused 
with something of the epidemic character under certain atmospheric 
constitutions. The discussion of such a question is indifferent and 
unsuitable here; epidemics of all sorts have their period of prevalence 
determined by season and circumstances; and the fact of the disease 
under consideration having ran its course with equal pace, under all 
the changes incident to a continuous interval of fifteen months, is 
sufficient to establish its relative independence of season, tempera- 
ture, and their combinations. In connexion with this view of the 
subject, I may remark that I took occasion to observe and inquire, 
and could not find one case of erysipelas, (not even of the sporadic 
or symptomatic form, every now and then to be met with,) in private 
practice of my own or others of the profession, for the whole time of 
its prevalence in the alms-house. Two cases have occurred, and ran 
their course out of the alms-house, yet having some relation to that 
establishment. One in a woman in the city, about ten days after she 
had been dismissed the alms-house in seeming good health. The 
other in the wife of the keeper of the public gate of the alms-house 
farm, who occasionally visited the alms-house, but had not for a long- 
time entered the hospitals. If those two cases be supposed to give 
intimation of a miasm about the alms-house, such conclusion is at the 
same time discountenanced by a multitude of adversary considera- 
tions, a part of which are that hundreds have been discharged during 
the course of erysipelas in the institution, among whom, as far as 
known, the disease has not afterwards occurred, except in the single 
instance noted, and hundreds remained about the establishment for 

* Another fact seems to contradict the presumption of hospital miasm, as the 
agent of the disease under consideration. For two years prior to June, 1827, 
there was not, (as far as I can learn,) any equal or similar spread of the disease 
in the house, nor even in the memory of the pupils, a single well-marked case 
of erysipelas during" that time. Since the date referred to, the disease in its 
most severe forms, was never absent from the house until the last of August, 
1828, about which time it ran out altogether, and no new case has arisen in the 
house from that time to this date, (4th of December, 1828.) 



40 Wright's Reports of Cases of Erysipelas. 

the whole period referred to, without incurring any participation of 
the disease. 

After all, there is much obscurity around the cause and mode of 
prevalence of a disease, having a sort of local habitation, attacking 
some, and passing by others under seemingly like circumstances ; and 
affecting at one time, or even altogether, a very limited proportion of 
the whole number, who have been at once, or in turn, exposed to its 
influence.* Perhaps the nearest approach that can be made to the 
true occasion of excitement to the disease, as it displayed itself in 
the alms-house, will be to infer the existence of something in the state 
of the constitution and habit of the individuals affected, inducing a 
peculiar susceptibility to erysipelatous incursion, or as it has some- 
times been expressed, creating an erythematic or erysipelatous dia- 
thesis. On such constitutions and habits, both local and general 
causes may combine to produce an effect. Hospital air, confinement, 
and moral causes, involving many circumstances of depression to 
mind and body, or creating an irritable state of both, may thus bring 
on the disease, or augment the liability to such a result from the 
agency of general causes, as vicissitudes of weather, the impression 
of a high or a low temperature, and possibly, during the season of its 
existence, the operation of a miasmatic agent. In a few of the cases 
of erysipelas occurring in the alms-house, especially those of the er- 
ratic form, the disease seemed to be associated with prominent dis- 
order of the gastro-hepatic functions, or superinduced and founded 
on the bilious diathesis. But such cases were rare, and in the general, 
no such concurrence or connexion appeared. 

The difference of opinion among respectable authors, as to the true 
character, definition, &c. of erysipelas and its varieties, is a matter both 
of interest and importance. The classification and description of Cul- 
len, Willan, &c. beautiful and satisfactory, because faithful to na- 
ture; fully comprehensive of the varieties of the disease, and long the 
guide and standard of pathologists and practitioners; late opinions 
emanating from high sources, instruct us to consider as too general 
and strained. Passing by others who hold the same sentiment, the 
author of the " Study of Medicine," the classical, learned, and in- 
genuous Good, has pronounced that the definitions of erysipelas by 
Cullen, Willan, Bateman, &c. are equivocal and arbitrary, and 

* Not more than from forty to fifty have been affected by erysipelas out of all 
who have been in the hospitals, or -who have come into and gone from them, 
during fifteen months. Even of those who have been in the wards for the whole 
of that time, a few only have suffered an attack from this disease. 



Wright's Reports of Cases of Erysipelas. 41 

confound modes of inflammation, essentially different in nature and 
cause. The main objection urged by Dr. Good against this classifi- 
cation, applies to the recognition on the part of the latter writers of 
a distinct variety of the disease under the name of " erysipelas 
phlegmonodes. " Good contends that a proper suppurative action 
" does not belong to any mode of erysipelatous inflammation," and 
that what has been mistaken for suppuration ensuing to that disease, 
is a "sanious fluid approaching the nature of pus," but that such 
fluid is never "true pus." He says farther with Pearson, that a 
" true phlegmon is never met with in erysipelas." . 

Now the answer to all this appears to be that the authors of the 
disputed definition, plainly never meant to identify strictly the sup- 
purative result of one mode of erysipelas, with " true phlegmon," as 
ordinarily produced. They designed to represent simply what the 
definition implies; that there was one form of erysipelatous inflam- 
mation having a tendency to, and often terminating in suppuration or 
abscess. That this position is sustained in fact, the observation of 
practical men will abundantly establish, and in the face of such sup- 
port, all cavil about the "genuine phlegmon"* of erysipelas, or of a 
"circumscribed cavity containing laudable pus, never occurring in 
erysipelas,"! seems wholly superfluous. Erysipelas often terminates 
in suppuration or abscess, no matter whether strictly circumscribed 
or more diffused, to great extent, and if the nature of the inflamma- 
tion and the state of the system affect the quality of the matter form- 
ed, so that it does not present the entire aspect of pure pus, neither 
does this fact alter the result so as to abolish or impair the correct- 
ness of the definition. It is still suppurative erysipelas, and entitled 
to the term "phlegmonoid," because no other appellation could bet- 
ter represent the state and consequence designed to be shown.} Dr. 
Good is surely in error, when he identifies " the sanious fluid ap- 
proaching the nature of pus found in parts of the vesication," with 
the purulent formations distinguished by Cullen, Willan, &c. in 
phlegmonoid erysipelas. The former is superficial, marking the 
change from the vesicular to the pustulous stage of the common erysi- 
pelatous exanthem. The latter is abscess in the sub-dermoid cellular 
tissue, often even more deeply seated, and involving the inter-mus- 

* Good. f Pearson. 

+ The super-nicety of discrimination applied to this question, would equally 
exclude from the order of suppurations all abscesses dependant on constitu- 
tional causes, so that by the rule set up, strumous abscess, (psoas for example,) 
shall not be termed suppuration, nor the matter of ripened tubercles be deno- 
minated pus. 

No. VII.— May, 1829. 6 



42 Wright's Reports of Cases of Erysipelas. 

cular cellular laminations with the fasciae and tendons proper to the 
muscles themselves, constituting a purulent collection, sometimes of 
a few ounces, and not infrequently amounting to many pounds.* 

I am sensible that apology is due for extending this paper to a 
length exceeding its merit, and I regret to trench so far upon the 
space of the journal. With this acknowledgment, I beg to report 
briefly two cases, bearing on the contested point of phlegmonoid and 
suppurative erysipelas. 

Nachel Shipley, an alms-house patient, while convalescing from a 
fever of the typhoid character, was affected by inflammation, pain, 
and Swelling of the left arm above and below the elbow. The faint 
colour, oedematous feel, and appearance of small phlyctenae or vesi- 
cles, distinguished the affection, as of the erysipelatous kind. By a 
free use of a stimulant, evaporating lotion, with strict rest, the local 
inflammation was so nearly dissipated that particular attention to 
the patient was discontinued. A week afterwards this man again 
presented his arm for examination; it was now more swelled than be- 
fore, and gave unequivocal signs of deep-seated abscess, both above 
the elbow and on the forearm. Free incisions were made at both 
points, and eight or ten ounces of thick, grayish-yellow matter, mix- 
ed with shreds of membrane, discharged. The parts among which 
the matter had been effused, coalesced readily; the incisions soon 
healed, and the patient was dismissed from hospital in a few days. 

Lodwick Forman entered the Alms-house Infirmary, January, 1827, 
for chronic catarrh, with other marks of general, low health. This 
man had also herpes circinatus of the face of many years standing. 
In February, 1828, he was attacked by erysipelas of the face and 
scalp. A bright red efflorescence appeared on the forehead, and ra- 
pidly overspread the face and head, accompanied by swelling, heat, 
and a tormenting sense of irritation in the part; the surface affected 
very soon exhibiting generally minute aggregated vesications. On 
the second day a circumscribed tumour appeared on the right side of 
the head, over the fronto-temporal angle. The tumour was deeper 
coloured than the rest of the face or scalp, and more painful than any 

* In the introduction to his remarks on erysipelas, Dr. Good labours to esta- 
blish the same distinction between erysipelas and phlegmon, as exists between 
phlegmon and small-pox. But if I do not mistake the application of the terms 
and analogies he employs, they will bear an interpretation that phlegmon and 
erythema may meet in a common result. I am not, however, desirous to con- 
vict the learned and excellent Good of inconsistency. There is obscurity about 
his illustration of the subject, and I may not have read him according to his 
design. 



Wright's Reports of Cases of Erysipelas. 43 

other part. It increased rapidly in volume, (still maintaining a de- 
finite circumscribed form,) until on the fourth day, the swelling was 
as large as an egg, and gave evidence of fluctuation. On the fifth day 
the apex of the tumour feeling thin, it was punctured freely, and dis- 
charged about an ounce of homogeneous, straw-coloured fluid, which 
I should denominate pus, though less thick than perfectly pure pus 
from acute phlegmon in a healthy habit. While this first tumour 
was maturing, another formed just behind it, above the e"ar. This 
was equally circumscribed as the former, rose to about the same 
magnitude, and after maturing, was opened, discharging contents 
similar in kind and colour to the matter of the first During the pro- 
gress of the second tumour, if phlegmon it must not be called, five 
more distinct individual swellings of a similar character displayed 
themselves on the same horizontal line of the head, and about an 
inch distant from each other, seated two on the occiput, two on the 
left parietal, and one on the left fronto-temporal junction, thus form- 
ing with the first two, a belt of tumours encircling the head. All 
those tumours suppurated, and were in turn emptied by puncture or 
incision, according to thinness or thickness of integument; all of them 
discharged a yellow, inodorous fluid, homogeneous, but rather less 
dense than the most pure pus. That those tumours were specimens 
of "true circumscribed abscess," was established by the fact that 
where two of the tumours came in contact in the course of their evolu- 
tion, and both of them were mature in suppuration at the same time; 
if one was incised freely, and wholly emptied, the adjacent one re- 
mained full, and a probe passed through the incision in the one, 
could not by any moderate pressure be made to penetrate the cavity 
of the other. This experiment was tried in two instances, and in 
each case it was necessary to open both cavities with the lancet or 
knife. That this was a case of pure erysipelas, its origin, course, 
and termination, place beyond doubt. Vesiculations overspread the 
face and scalp, ending in copious desquamation of both; the whole 
cuticle peeled from the face, and was broken up and thrown off from 
the scalp, the latter taking the hair with it, and leaving the patient 
quite bald.* This was a case of erysipelas, too, ending in abscess, 
so near to phlegmon, as to leave no small difficulty where to fix the 
discrimination. The erythematous efflorescence in this case extend- 
ed over the ears, and into the meatus externus, producing a free dia- 

* He has since a full growth of new hair; the herpes of the face which had 
existed for years in this man's case has wholly disappeared since erysipelas oc- 
cupied that seat. 



44 Wright's Reports of Cases of Erysipelas. 

charge from both external auditory passages, very much resembling 
that " sanious fluid approaching the nature of pus," which Dr. Good 
seems to regard as the only suppurative effort proper to any form of 
true erysipelas.* 

Dr. Good has also pronounced the classification of Willan incor- 
rect, as it applies to some other forms of erysipelas, namely, to what 
the latter defines as Erysipelas cedematodes, and E. gangrenosum; nei- 
ther of which, Dr. Good says, ought to class with the species Erysipe- 
las, but belong of right to the genus Erythema. It is not proper to de- 
vote a paper like this to the business of adversary discussion, nor is 
such its design. Yet it may be remarked, that even Dr. Good ad- 
mits, that in one of the two varieties into which he distributes Erysi- 
pelas, (E. erratica,) M the part affected sometimes assumes a livid 
hue, and is covered with petechia; the cuticle separates, the cutis 
breaks, and exposes a foul ulcerated surface, which soon passes into 
gangrene." During the course of erysipelas in the Alms-house, one 
or two cases occurred, of both the oedematoid and gangrenous forms. 
Those cases I had proposed to report, but this paper has exceeded 
the limit intended at its commencement, and I forbear the detail of the 
cases in question. I am not the advocate of multifarious classifica- 
tion, nor anxious to retain or restore nosological exuberances, which 
able and ingenious pathologists are endeavouring to lop off, in order 
to clear the field of medical science; but we may be allowed some 
space for deliberation and inquiry, before exchanging for others, 
terms and definitions of morbid states, long familiar to the profes- 
sion, and which have come down to us from a remote era, receiving in 
their course the confirmation of men eminent alike for the extent and 
accuracy of their observation. Dr. Good has laudably endeavoured to 
establish a natural arrangement of diseases, and to give them dis- 
tinctness and precision of definition; and if he has attempted a great 
deal, he has also performed much. His works form a noble monu- 
ment of learning and labour, exhibiting unsurpassed industry of re- 
search, with a rare tact of discrimination, allied to the most honour- 
able candour and impartiality. The profession of medicine owes 
him a meed of respect, which its present or future members shall 
hardly sufficiently pay; yet it may admit a doubt, whether the classi- 
fication and nomenclature of the " Study of Medicine," (beautifully 

* Mr. Pearson has remarked, and Dr. Good quotes the expression, "that 
purulent effusion, or a sort of suppuration, sometimes supervenes to erysipelas, 
in which the cellular membrane suffers great injury, and the part is commonly 
in a gangrenous state." 



Wright's Reports of Cases of Erysipelas. 45 

explicit as it certainly is in the general,) is not in parts, rather fan- 
ciful and constrained, than natural or just, and more fitted to con- 
fuse than to instruct. Such I conceive to be the case, in its applica- 
tion to some of the morbid states hitherto distinguished as erysipela- 
tous. I cannot see the benefit or improvement to result, from divorc- 
ing, under separate heads, and by new terms, modes of local inflam- 
mation so often found associated, and so generally known by terms 
in familiar use. Erysipelas, as a local affection, is commonly sympto- 
matic of some more general error of health, and arises from irritation 
of some kind, superadded to previous disorder of state and function, 
either in the part, or the constitution, or both. As a mode of inflam- 
mation, it is not susceptible of strict and invariable definition, be- 
cause it is eminently liable to great and rapid change of sensible cha- 
racters, dependent on the varying state of the part and the system. 
The inflammation of erysipelas may and does pass, in a brief inter- 
val, from its most simple form of superficial efflorescence, through all 
its intermediate states, down to its issue in gangrenous undefined ul- 
ceration. Inflammation, intrinsically the same in nature, will thus 
perhaps have assumed, in a short time, the successive, (ostensible,) 
characters of erythema, or Erysipelas simplex, E. vesiculosum, 
phlegmonodes, cedematosum, and gangrenosum; terms designed to 
discriminate not different kinds of inflammation, but the contingent 
circumstances or actual state of a mode of inflammation, susceptible 
of obvious changes, to which the added terms have a relative and cor- 
respondent application. ' 

A case lately occurred in the Baltimore Alms-house, affording a 
very interesting display of that mode of inflammation which Dr. Good 
defines as Erythema cedematosum. 

A man was brought to the Alms-house early in December, ex- 
tremely ill, with general paralysis, fugitive delirium, and fever of 
the congestive typhoid character, contracted by exposure to incle- 
ment weather, while working on the Baltimore and Ohio Rail -road. 
On admission, an unusual fullness was noticed at the top of the ster- 
num, extending over both sterno-clavicular articulations. The inte- 
gument over that seat was prominent, as if either swelled by infiltra- 
tion, or pressed forward by uncommon adipose accumulation. The 
part was carefully examined, and suspicion was entertained that the 
enlargement was morbid, and belonged to those bad forms of local 
inflammation, occasionally concomitant of typhoid fever of exalted 
irritation, yet there was neither pain of the part on pressure, nor the 
colour, tension, or heat attendant on inflammation. The enlargement 
was looked to every day, and manifestly increased in volume and ex= 



46 Wright's Reports of Cases of Erysipelas. 

tent of surface, becoming broader and more prominent. On the third 
day after admission this part wore a faint red colour, which receded 
and returned as pressure was made or taken off; some heat too was 
perceptible, and the part now pitted slightly on pressure, giving 
signs of infiltration with softening or oedema. By the fifth day, the 
enlargement had extended half the length of the right clavicle and 
two inches above the clavicle on the neck, was a good deal rounded 
in front, and gave to firm pressure in opposite directions, evidence 
of deep-seated effusion. The character of the fluctuation was emphy- 
sematous, or rather crepitating as in comminuted fracture. The fluid 
was of moderate amount, and covered in by a very firm wall of inte- 
gument and condensed cellular membrane, and on this account its 
discharge by incision was not performed at the moment, but in con- 
sideration of the propriety of an early evacuation of such collections, 
especially when forming around articulations, or adjacent to impor- 
tant cavities, it was decided not to postpone an incision longer than 
to the following morning. On the next day, the tumour, which had 
been the day before pretty much defined in outline, rounded, and 
somewhat firm, had undergone a remarkable detumescence, was un- 
defined, flattened, and soft, affording scarcely a sign of fluid collec- 
tion. At the same time a very obvious fullness, with some prominence, 
was apparent under the whole clavicular margin of the right pectoral 
muscle, and the body of that muscle was preternaturally prominent, 
and pressed forward, as low down on the chest as the line of the fifth 
rib. It was apparent that the fluid which had been somewhat concen- 
trated the day before, was now diffused under the right pectoral 
muscle, and the end designed by incision was no longer attainable. 
The result which the operation mainly contemplated to avert, was 
already accomplished. A discovery was made on this day, (the sixth 
after admission of the patient,) which seemed to import that the con- 
dition of parts concerned in the abscess was worse than our greatest 
fears had anticipated. While feeling around the part affected, it was 
discovered that every touch of the right clavicle caused a grating like 
that of fracture, and on grasping the clavicle with the thumb and 
finger, and giving it pressure upward and downward, crepitation was 
perfectly distinct, and the movement of the clavicle itself so free, as 
to prove clearly the fact of its complete disjunction at the sternal ex- 
tremity. On drawing down, pressing up, or rotating the arm, the cla- 
vicle gave the same grating on the sternum, and the same loose play 
of movement, as when itself directly pressed on; the sterno-clavicu- 
lar articulation was totally broken up. This state of parts accounted 
for the (supposed) emphysematous character of the fluctuation on 



Wright's Reports of Cases of Erysipelas. 47 

the first day that fluid accumulation was detected, and the unfortu- 
nate result seemed to admit of but one interpretation $ inflammation 
of the cellular tissue and skin around the sternal extremity of the cla- 
vicle, had run on to that form of ulcerous sloughing abscess, charac- 
teristic of phlegmonoid erysipelatous affection, the erythema of Good, 
" cedematose inflammation" of Hunter; or according to Earle, 
Scott, and others, " diffuse inflammation of the cellular membrane;" 
and the sterno-clavicular ligaments were destroyed in the sloughing 
ulcerous degeneration. When this explanation of the local mischief 
was offered, one of the pupils of the house suggested the probability 
of accidental fracture or dislocation, as a cause of the existing state 
of the parts. He had learned, that on the day the patient became 
sick, he had been in a frolic with many others, and had exerted him- 
self very much in wrestling, had received some hard falls, and might 
thus have suffered violence to the part, followed by the consequences 
as described. A kind of injury, and a condition of parts very similar 
to what existed in the case before as, might possibly have arisen from 
the cause suggested, yet I adhered to the opinion first advanced, that 
this was a state of things wholly independent of local violence, and 
strictly symptomatic of the character of the fever. The patient's ge- 
neral symptoms were milder at this time than when he was admitted, 
yet I considered the local affection as betraying intense disorder of 
the constitution, and giving most unpropitious omen of the final result. 

On my visit the day following, the nurse of the ward called my at- 
tention to the left arm of this patient. He had found the wrist of that 
arm the evening before sore to the touch, and showing signs of in- 
flammation, and had applied a bread poultice to the part. On the 
next morning the wrist was swelled, high-coloured, and hot. The 
inflammation appeared first in a circumscribed red spot over the 
tubercle of the ulna, at its radial junction, and in the course of the 
night spread around the whole wrist. The parts were now much 
swelled, and pitted slightly on pressure; fluctuation could not be de- 
tected. On the third day, deep abscess formation was developed, 
and a thin pus, slightly sanious, discharged by free incision. After 
emptying the part by gentle pressure, the ulna rose over the radius, 
and was found totally free of attachment to that bone, its connexions 
being destroyed by ulceration, and allowing the carpal extremity of 
the ulna free motion; when moved it made very distinct crepitation 
on the radius, and the same character of rough friction was produced 
in the carpo-radial articulation, by giving movement to the hand. 

At the time the abscess of the left wrist was opened, the patient 
requested me to examine his left knee, which was sore to pressure, 



48 Wright's Reports of Cases of Erysipelas. 

and very sensibly swelled 5 the tumefaction was chiefly about the im- 
plantation of the tendon of the rectus and vasti into the head of the 
patella, and there seemed to be considerable effusion under the ten- 
don. This enlargement differed in appearance from the inflammation 
on the sternum, and around the wrist, the former showing no signs 
of suppuration, the effused fluid appeared to be in the great bursa 
under the tendon of the rectus, and the whole swelling resembling 
more rheumatic infiltration than phlegmonoid abscess. 

On the day following, the appearance of swelling, &c. around the 
knee, the right wrist displayed an inceptive stage of inflammation, 
intumescence, &c. similar with that of the left, but the patient now 
began to sink sensibly under the exhausting effects of protracted 
fever, complicated with local irritations calculated to react with se- 
rious disturbing influence on the constitution, and his death happening 
two days after the commencement of the affection of the right wrist, 
prevented complete development in this new seat of symptomatic in- 
flammation. 

Examination after death disclosed the following state of parts at 
the points of abscess formation. The primary seat of the matter at 
the top of the sternum was empty, but five or six ounces of gangrenous 
pus was found diffused between the greater and less pectoral muscles, 
the matter accumulated along the line of the right clavicle, chiefly 
toward its humeral extremity; no matter appeared above the clavicle. 
The sternal end of the right clavicle was loose, separated from the 
sternum, and standing above it. ' The articular surface, bare, rough, 
and sensibly wasted by ulceration, the interclavicular ligament, the 
anterior and posterior, with the proper capsular ligament of the right 
clavicle, were destroyed, the end of the clavicle was of a deep dark 
red colour. The head of the sternum was, more than any other 
part, the seat of necrosis; it was carious for an inch downward, 
and what was remarkable, had separated into three pieces; one re- 
mained adherent to the left clavicle, (which was not disarticulated,) 
the middle portion lay loose and insulated, and a portion one inch 
long by three-fourths of an inch broad, was firmly united to the first 
rib of the right side and the right clavicle, the two latter remaining 
connected by the rhomboid ligament. The necrosed and separated 
portions of the head of the sternum, and the adjacent part of the body 
of that bone, like the end of the right clavicle, were of a dark red 
colour. None of the matter of this undefined gangrenous abscess had 
invaded the cavity of the thorax; the membranes within, under the 
head of the sternum, were but little discoloured, and not sensibly 
altered, except by some thickening. 



Hay ward on the Use of Prussia Acid. 19 

The condition of the parts involved in the abscess at the left car- 
pus, was the same as had been found at the top of the sternum. The 
ulna was disarticulated; its coronary ligament was destroyed; the 
carpal end of the ulna bare, partially carious, and of a dark red co- 
lour. The capsular ligament of the carpus was also in part destroyed, 
and the articular cavity filled with sanious pus; the bones forming 
that joint were all tinged with the hue of inflammation, but the two 
bones corresponding most nearly to the carpal end of the ulna were 
quite bare of cartilage, rough, and of a very dark red colour. The 
forearm was separated from the arm, and its muscles carefully dis- 
sected away, in order to preserve the carpus as a morbid specimen; 
and in this state the ulna presented a striking appearance at its hume- 
ral extremity. The olecranon, and the sigmoid concavity, but espe- 
cially the coronoid process, were of a high red colour, not superficial, 
but evidently pervading the solid structure of the bone, as the colour 
was not discharged or diminished by maceration. The shaft of the 
ulna was of the same deep red hue for an inch in advance of the coro- 
noid process, but in and around the latter the red colour was particu- 
larly intense. On careful inspection of those points of the ulna, I was 
convinced that the colour was an effect of a morbid state of the bone, 
and not a casual tinge from stasis, post mortem infiltration, or other 
common causes; the bones of the same arm no where else presented 
similar characters, and I could not but draw the conclusion, that had 
the subject of this violent disease lived a few days longer, abscess, 
with gangrenous caries, would have been developed within the elbow 
joint. 

Baltimore, Dec. Q2d, 1828. 



Art. III. Remarks on the Use of Prussic Acid. By George Hay- 
ward, M. D. of Boston. 

X HERE can be no doubt, I think, in the minds of those who have 
any practical experience on the subject, that Prussic acid is possessed 
of valuable, as well as powerful properties, and yet, if I am not mis- 
taken, the use of it as a remediate agent has diminished in no small 
degree within the three or four last years. This must be attributed 
to the extravagant praise that has been bestowed on it, to its having 
been extolled for properties which it does not possess, and recom- 
mended as a specific for diseases, over which it has since been found 
No. VII.— May, 1829, 7 



50 Hay ward on the Use of Prussic Jlcid. 

to exert little or no control. The physician who expects to cure 
phthisis pulmonalis with Prussic acid will, probably, in every case 
be disappointed, and it is to disappointments of this sort we must 
look for the explanation of the fact, that this article is now ranked 
by most members of the profession below its real value. 

It is, however, a remedy that should not be entirely overlooked, 
and when employed only in those cases in which its use is indicated, 
will be found not unfrequently a valuable auxiliary to the curative 
means we already possess. It is not my purpose in this article to 
give any thing like a full treatise on this medicine, but to call the at- 
tention of the profession to it, by stating my experience concerning 
it, indicating some of its properties, and some forms of disease in 
which I have found it useful. I shall briefly give the results to which 
I have arrived in my own mind on the subject, without a detail of 
cases, and point out the •preparation of the article which I have used, 
the complaints in which it has been exhibited, and the dose in which 
it has been administered. 

The Prussic acid which I first used was that known by the name 
of Scheele's preparation, and is the same as that usually employed 
in Europe for medicinal purposes. It is very nearly of the same 
strength as that of the Pharmacopoeia of the United States, but is less 
convenient, being more liable to decomposition. This is owing to 
the double distillation to which it is subjected in the process of making,' 
which frees it almost entirely of sulphuric acid; that formed according 
to the pharmacopoeia undergoes but one distillation, and a sufficient 
quantity of sulphuric acid remains to prevent it from speedily decom- 
posing. Of late years, therefore, I have used the latter altogether, 
and have been unable to discover any difference between the strength 
of this, and of that of Scheele's preparation.* 

In confirmed phthisis pulmonalis, I am satisfied that the Prussic 
acid is of no service; on the contrary, I believe that it is oftentimes 
injurious. When the lungs are ulcerated, or when there are tubercles 
in them in a state of suppuration, attended with a frequent pulse, 
chills, heat, and night sweats, this medicine cannot be exhibited 
to advantage, and by checking the cough and expectoration, while 
the secretion of pus continues, will frequently be productive of mis- 

* The Prussic acid that I have been most in the habit of using has been made 
by Mr. Daniel Noyes, an excellent practical chemist of this city. I have found 
it of very uniform strength, and have never known it to decompose. He in- 
forms me, that when he prepared it in the old method, by a simple distillation, 
the decomposition was prevented by adding a small quantity of sulphuric acid 
to it. 



Hay ward on the Use of Prussic Acid. 51 

chief. From the recommendation of European writers I employed 
this acid, soon after its introduction into the materia medica, in se- 
veral cases of phthisis, and being uniformly disappointed in deriving 
any benefit from it, I was for a time inclined to abandon it altogether. 
But observing that in every instance it had a tendency to allay the ir- 
ritability of the system, at the same time that it diminished the cough, 
the idea occurred to me that there was a class of pulmonary diseases in 
which it might be of benefit. Subsequent experience has satisfied me 
that this view of the subject is correct, and I have since been highly 
gratified with the effects of the preparation in numerous instances. 

We often meet with patients, especially females, labouring under 
a cough of great urgency and violence, which is kept up by an irritable 
state of the system, and which sometimes seems to be increased 
rather than diminished by the ordinary remedies. Though there is 
no disease of the lungs at the time, if the cough be permitted to con- 
tinue, an organic affection is likely to follow. In cases of this descrip- 
tion Prussic acid will exert a most salutary influence, and not un- 
frequently allay in twenty hours the violence of a cough of several 
weeks standing. A lady had laboured under a nervous cough of this 
character for more than six weeks, and, from the violence of its pa- 
roxysms, had passed nearly sleepless nights during the whole of that 
period ; all the ordinary remedies, such as blisters and expectorants, 
having been tried in vain, small doses of the submuriate of mercury 
combined with opium were administered till the system became af- 
fected, but yet no relief followed. The Prussic acid v/as then ad- 
ministered, and all other remedies laid aside, she slept several hours 
without interruption the first night after taking it, and within a week 
the cough was entirely gone. 

In the latter stages of hooping-cough, when there is little or no 
congestion in the lungs, and no accumulation of mucus in the air 
tubes or cells, two or three doses of this medicine will oftentimes put 
an entire stop to the disease. In some cases I have seen it operate 
like a charm, a single dose being sufficient to give the little sufferer 
complete and permanent relief. It is only, however, in the latter 
periods of this disease that I should think it either judicious or safe 
to administer it, and at this stage I have given it to children of all 
ages, and in most instances with great benefit. 

There is another form of disease in which I have employed Prussic 
acid, and in which I think it promises to be of great advantage, and 
that is painful menstruation. Within a few weeks a lady who, for 
two or three years past, has been in the habit of taking from six to 



52 Hay ward on the Use of Prussic Acid. 

twelve grains of opium in a day during the period of her menstrua- 
tion, without obtaining great relief, omitted, by my advice, in the 
three last returns of the catamenia, the opium, and took the Prussic 
acid, and she has since informed me, that she has not for years had 
so little pain at that period as under the use of this medicine. My 
experience with it, however, in this affection, has not been very ex- 
tensive, but having seen decided benefit from its use in the few cases 
that have fallen under my notice, I shall not fail to employ it when- 
ever a proper case of the kind offers. 

In the various forms of hysteria this medicine may be advantage- 
ously employed, and I have been much pleased with its effects in 
lessening the violence of the paroxysms of this disease in some cases 
in which I have administered it. From the great power which it ex- 
erts over the nervous system, acting apparently as a more perfect se- 
dative than any thing else with which we are acquainted, it would 
seem to be particularly adapted to allay the violence of hysterical af- 
fections. 

It having been spoken of by Dr. Granville as an useful remedy for 
asthma, I gave it a trial in several cases, and regret to say, that I 
have never in a single instance derived the slightest benefit from it 
in this disease. We certainly should not conclude, reasoning a priori, 
that it would be advantageous, if we admit the pathological views 
which have been taken of asthma by Dr. Wilson Philip. He con- 
siders this disease, I believe, to be owing to a diminished energy of the 
respiratory nerves, and hence galvanism, by increasing this energy, 
affords relief. 

Be the theory what it may, I should certainly not again administer 
Prussic acid to an asthmatic patient; not that I ever saw it produce 
any permanent injury, but I certainly never discovered any benefit, 
and have thought that it has sometimes prolonged the paroxysm of 
the disease. 

These are the only diseases in which I have ever used this medi- 
cine,, and I have briefly, but fairly, stated its effects. They have 
been such, on the whole, as to induce me to employ the article, 
in future, in other cases of the kind, though they have not been such, 
perhaps, as might have been expected, from the exaggerated accounts 
that have been published of the virtues of this remedy. 

The dose which I have been in the habit of exhibiting is much less 
than what is frequently recommended, nor do I ever continue it more 
than three or four days, if a decided good effect is not produced in 
that time. Both these precautions appear to be necessary when the 



Hay ward on the Use of Prussia Acid. 53 

terrible power of the article is considered, and the sudden manner 
in which it sometimes manifests its deleterious influence on the system. 

My practice, in all cases in which I use this medicine, is to mix 
one part of the acid with one part of syrup of tolu and two parts of 
distilled water, so that the mixture contains but one-fourth part of 
acid. The advantage of this is, that the dose of the acid may be 
more easily increased in a minute quantity. 

To adults I usually administer two drops twice a day, that is, eight 
drops of the mixture spoken of above, which is gradually increased 
till the patient takes eight drops of the acid twice a day. I never 
exceed this quantity, nor do I believe it to be necessary, if the me- 
dicine be good; I think it could not have been so in some of the cases 
which have come to my knowledge, where patients have been said to 
have taken forty drops three times in twenty-four hours. 

To children under two years of age, to whom I have administered 
the Prussic acid for the hooping-cough, I have never given over a drop 
and a half at a dose, nor given more than two doses in a day. 

There is one effect which has uniformly followed its prolonged ex- 
hibition in my practice, which is, the production of diarrhoea. It has 
not unfrequently happened, that this has been so severe and so little 
under the control of opium, that I have been compelled to suspend 
the use of the medicine. I mention this more particularly, as one or 
more writers speak of its power in checking the diarrhcea that usually 
comes on in the latter stages of phthisis. 

Administered in the doses mentioned above and continued only 
for a short time, if decided benefit did not soon follow its exhibition, 
the Prussic acid has ever been in my hands a perfectly safe remedy, 
and though I have prescribed it to more than two hundred patients, 
it has not produced in a single instance any unpleasant symptoms, 

Boston, March, 1829. 



54 Horner on the Nervous System. 



Art. IV. Contributions to the Physiology and Pathology of the 
Nervous System. By W. E. Horner, M. D. Adjunct Professor 
of Anatomy in the University of Pennsylvania. 

JL HE following cases are offered as contributions to our knowledge 
of the nervous system; a subject upon which the labours of Gall, of 
Bell, of Serres, of Flourens, &c. have shed a flood of light, but many 
points of which require further elucidation, and still more remain in- 
volved in utter obscurity. 

Case I. Chronic Hydrocephalus^-^Present, Dr. J. K. Mitchell, 
attending physician, and Dr. S. Jackson. Autopsy eighteen hours 
after death. Weather moderate. 

Master M. aged eight and a half years; had his head no larger than 
usual at the period of his birth. At the age of six weeks symptoms of 
hydrocephalus were manifested, for which he underwent an active 
treatment which was continued for some time. As he advanced 
in age he began to walk; his head continued to grow inordinately; 
his stature was not much affected, and he reached almost the size 
which is common to boys of eight years. He could walk, run, 
and participated in the amusements common to childhood; was sent 
to school, where he learned very readily the subjects usually taught; 
was remarkably smart, sprightly, and intelligent in his conversation; 
was very fond of music, and learned readily a variety of tunes; his 
memory was also excellent. 

For a long time after birth, the sutures of the cranium were open, 
and the fontanelles unusually large; the ossification was, however, 
finally completed, and the cranium became firm. The size of his head 
was so great that he attracted much attention; and he was apt to fall, 
especially forwards, from readily losing his equilibrium. 

Dec. 12th, 1828, he fell against a door, and bruised his forehead 
on the left side considerably. In an hour afterwards he vomited, be- 
came very sick, and took to bed, and died the next evening about 
nine o'clock. The subsequent day, at three P. M. we proceeded 
to examine his head. Its dimensions were as follows: the largest 
horizontal circumference of the cranium measured around the frontal 
and parietal protuberances was twenty-eight inches; peripheral dis- 
tance between meatus auditorii externi, nineteen and a half inches; 
peripheral distance from root of nose to occipital protuberance, nine- 
teen and a half inches. 

Diameters measured with Callipers. — Anteroposterior, 9 T 3 ^ inches 



Horner on the Nervous System. 55 

— Between parietal protuberances, 71 do. — Between temples, back 
part, 7 do. — From chin to vertex, 10 do. — Between meatus auditorii 
externi, 5 do. 

The bones of the cranium were of the thickness common to chil- 
dren of his age, and the sutures firmly fastened, the sagittal was 
continued to the root of the nose. There was an os triquetrum on 
each side of the frontal suture, but no other supernumerary pieces. 
The integuments of the head were thin and stretched. 

The dura mater adhered firmly to the cranium, especially along 
the sutures. The pia mater was vascular; no pathological state was 
perceptible in the arachnoidea, either internally or externally. The 
convolutions were much shallower than usual, being about a third the 
common depth. 

The lateral ventricles together contained five pints of limpid trans- 
parent serum, and were distended into perfect bags; the thickness 
of the cerebrum around them varied in places from four to eight 
lines. Having made a long cut from above into each lateral ventricle, 
I found the medullary surface of the ventricles disposed to separate 
itself from the contiguous part of the cerebrum. The corpus callo- 
sum was thinned to about one line, and stretched to the breadth of 
an inch and a half, and its raphe was semi-diaphanous. Beginning, 
therefore, at the corpus callosum, we peeled the upper circumference 
of the lateral ventricle off, as one would tear off paper from a wall; 
we continued to trace the layer along, and stripped off in the same 
way the lower circumference of the lateral ventricles, the layer 
coming off successively from the hippocampi, and from the thalamus; 
we found this layer continuous with the fornix which was raised up 
in the progress of this peeling process. I endeavoured to strip by 
the same process the surface of the tubercula quadrigemina and the 
valve of the cerebellum, bv the continuation of structure with the 

' ml 

surface of the thalamus, but it failed. 

The process was executed on both lateral ventricles with equal 
facility, so that a medullary layer one line in thickness was stripped 
off completely from the whole periphery of each lateral ventricle, be- 
ginning at the corpus callosum and ending at the internal side of the 
thalami. It is worthy of specific notice that a cineritious layer of the 
same thickness, and continuous with the other, came off from the sur- 
face of the corpus striatum. 

The septum lucidum was wanting in great measure, there being a 
free communication of the lateral ventricles of some inches in diame- 
ter between the corpus callosum and the fornix. The margin of the 



56 Horner on the Nervous System. 

imperfect partition formed by the septum was rounded, and had no 
appearance of laceration. 

The cineritious substance of the cerebrum was softened, and 
followed the pia mater in stripping off this membrane. But the 
cineritious substance could not be detached clearly from the sub- 
cineritious medullary substance in consequence of their intimate 
coalition. 

Taking then the thickness of the cerebrum into view, from its sur- 
face to the surface of the lateral ventricles, there were evidently made 
out three layers of matter, the external cineritious, then the sub-cine- 
ritious medullary layer forming the convolutions and their bases, 
and then the layer of medullary matter forming the periphery of the 
ventricles. These two layers of medullary matter seemed perfectly 
distinct from one another, 1st, by the almost spontaneous separation 
which they made when it first attracted our attention, and then the 
perfect facility with which the ventricular layer was stripped off uni- 
versally from the other. 2d, In examining the vascular arrange- 
ment, it appeared that the adjacent surface of each had their capil- 
laries branching out distinctly, as is the case with contiguous but dis- 
tinct membranes elsewhere. 

The capillaries of the encephalon were generally congested with 
red blood. The cerebellum, pons, crura, and the base of the ence- 
phalon was healthy. There was no sub-arachnoid infiltration any 
where, the convolutions being close and compacted. 

The examination was not extended beyond the head. 

For preparations of peripheral layer of ventricles, see Anat. Mu- 
seum. This was the only part we were permitted to bring away. 

I am indebted to Dr. J. K. Mitchell, the family physician, for the 
following minute history of the patient, in a letter to myself. 

" William M. was born in Philadelphia on the 4th of June, 
1820, the fourth child of his parents. Although his entrance into 
the world was tedious, no remarkable difficulty attended his birth, 
nor was there at first perceived any peculiarity in his conformation. 
When about six weeks old, incessant cries and a distressing restless- 
ness indicated the existence of pain, and in a few hours he became 
incapable of drawing nourishment from his mother, making many 
fruitless essays with a smacking sound. A physician, after examin- 
ing his mouth, and dividing the frenum linguae^ expressed some fears 
of the occurrence of disease of the brain. Severe and protracted 
diarrhoea soon followed, and a very manifest enlargement of the head 
confirmed the opinion of the medical adviser. 



Horner on the Nervous System, 57 

After a variety of treatment, the general health of the child was 
restored, and continued unimpaired until about a month before his 
decease, which happened on the 13th of December, 1828, when in 
the 9th year of his age. During the whole of this period of nearly 
eight years, his head continued to enlarge without being connected 
with the slightest head-ache, or any functional derangement whatever. 
The bones of the cranium became firmly united, and the fontanelles 
closed in his fifth year. 

When fifteen months old the child spoke well, and at eighteen 
months was able to sing a variety of musical airs with tolerable cor- 
rectness; and always exhibited a strong predilection for music. 

Nearly four years elapsed before he was able to balance himself on 
his legs, and he was not a confident walker until five years of age. 
Indeed, the great weight of his head rendered him always very liable 
to falls, and caused him frequently to impinge upon his forehead. 
Sometimes, when at school, he fell backwards from the form. 

His intellectual faculties generally were very respectable, and his 
powers of observation rather remarkable. But his memory both of 
language and sentiments, was such as to create surprise in those who 
took the pains to converse with him. The following example of his 
powers of recollection may not be amiss. A customer of his father 
having been absent two years, returned, and on his entrance into the 
shop, saluted as an acquaintance its inmates; but they had forgotten 

him. On turning to little M , the latter immediately called him 

by name, inquired kindly about him, and then told him that he had 
not been to see them for two years. 

Of a grave and quiet temperament, he preferred the society of 
his seniors, and took little interest in the common pastimes of child- 
hood. Only sedate children were agreeable to him. 

For so youthful a person, his sentiments and affections were of a 
lofty character. Seeing the distress of his mother, when commercial 
affairs took his father to Europe, the child, then five years of age, 
said, « Father will soon be back; if he dont come again, I will be a 
husband to my mother, and will work for her and take care of her 
when she is old.' 

For two years before his death, little M. became affected by 
religious impressions, which grew stronger and stronger until his 
death. Often advising others, he presented in his own conduct a 
fine exemplification of his principles, being distinguished among the 
children of the family and the school, for love of truth and general 
sincerity of character. At length, even while in full health and vigour, 

No. VII.— May, 1829. 8 



53 Horner on the Nervous System. 

he spoke of death as a thing to be desired; and when dying, express- 
ed pleasure at the approaching crisis. 

On Sunday evening, several weeks before his decease, he was 
seized with severe nausea and vomiting, which having subsided, re- 
turned on the following Sunday, and so on with weekly intervals, 
until, on Friday, the 12th of December, a severe fall, followed in 
eight or ten hours by like symptoms, terminated his existence. 

During his short illness, he referred all his pain to his stomach, 
and never complained of head-ache or vertigo. His pulse became 
gradually slower and more feeble, the temperature of the surface de- 
clined: but his mental faculties, and his affections, remained un- 
changed until he was in articulo mortis. 

The singular nature of this case, together with the curious anato- 
mical facts disclosed by your post mortem examination, induced me 
to make a minute inquiry into the history of the subject of it, previ- 
ously to the period at which I was called to visit him, which I now 
beg leave to convey to you." 

Case II. Dropsy of Brain and Tumour on Cerebellum producing 
Hemiplegia, Blindness, Deafness, Loss of Touch, fyc. fyc. — Mrs. 
Rebecca D. setat. about thirty, the mother of two young and healthy 
children, and of a good constitution, was taken in the spring of 1827, 
with symptoms of paralysis after some slight indisposition. I saw her 
in August, and the symptoms were then, intermittent loss of vision 
in left eye, slow winking on that side, difficulty of hearing, and of 
articulation, loss of taste on left side of tongue, pain in the back 
part of the head, incessant roaring in her left ear, mouth drawn to 
right side. Diminished myotility in left upper and lower extremity, 
and inclination of the body to that side when sitting; in walking 
across the room with assistance, she invariably swerved from the 
straight line towards the left side, so that her motion became diago- 
nal to the left. 

She also complained of pain in the bladder, especially on making 
water; and whilst I was examining this organ a few days afterwards 
with a catheter, she was suddenly seized with an epileptic fit, to 
which, under the name of faintings, she had been subject for several 
months, having had attacks upon any sudden emotion even when a girl. 

Her functions in other respects were healthy, and her menses re- 
gular. 

I treated her by adopting repeated leeching to the temples, bleed- 
ing from the arm, blisters on back of neck, and on temples; light 
nutritious diet, with some ligneous teas, as sarsaparilla, valerian, and 



Horner on the Nervous System. 59 

from time to time, from three to five grains of blue mass or cathartic 
pills of aloes and calomel daily. She improvedso much under this 
treatment in four or five weeks, that she ceased to occupy her bed 
habitually, improved in flesh, could, by clinging to the furniture, 
take her turns around the bed room, and finally got down stairs. The 
several symptoms stated, all got better, excepting the roaring and 
pain in the head. 

With occasional slight changes for better or for worse, she passed 
through the winter. In the March of 1828, the symptoms being sta- 
tionary, Dr. Parrish was joined in consultation, and upon his sug- 
gestion, rust of iron was taken to the amount of eight or ten grains 
three times a day, and an issue was permanently fixed on each side 
of the head after she had been twice blistered all over it. This treat- 
ment was persisted in for two months without benefit; her mouth 
became sore from the steel rust, and she complained of its heating 
her stomach. 

In the progress of this part of the treatment, I observed for the 
first time, though the symptom might have been constantly present, 
that there was a loss of sensation in the skin of the left side of the 
face, from the middle line backwards, and that the left conjunctiva 
was also torpid, so that it like the skin might be scratched with the 
end of a straw without her feeling it. 

Her epileptic paroxysms during all this time recurred irregularly at 
intervals of ten, fifteen, or twenty days. In the latter part of June, 
1828, she went into the country by advice, and was absent till about 
the end of August. On her return, the symptoms were for the most 
part aggravated. She had become thinner ; her stomach rejected fre- 
quently its contents; I thought that this might arise from emetics of 
twenty grains of ipecacuanha each, having been administered to her 
in the early part of the summer three times a week for four or five 
weeks in succession, just before she left the city. The value of this 
opinion will, however, be seen from the dissection. The blindness 
of the left eye, which formerly had been only intermittent, now pre- 
vailed incessantly, with occasional blindness of the right also, the 
deafness of the left side had increased with the noise and pain in her 
head at the back part; insensibility of left side of face the same; to 
this was added a diminished myotility in it, keeping it almost sta- 
tionary when she talked; left side of tongue insensible to taste, mouth 
drawn somewhat to right side, myotility of left extremities also dimi- 
nished, but no want of sensibility in their integuments. 

Her menses had now been suspended for four months, and her 



60 Horner on the Nervous System. 

bowels were disposed to constipation; there was a more frequent re- 
currence of the epileptic paroxysms. 

From this period, (August 28th,) till the day of her death, (Octo- 
ber 19th, eleven o'clock P. M. in an epileptic fit,) the symptoms in- 
creased regularly and gradually, total blindness supervened for a 
month previous to death, she could no longer sit up out of bed with 
any comfort, her articulation became thick and slow, her swallowing 
difficult and slow, and when the food was down it was frequently 
brought up again involuntarily; and what was remarkable, the pro- 
cess was a sort of ruminating one, for she could immediately after 
swallow with an appetite, and digest well; this leads us to infer that 
the mucous coat was sound in its office, and the muscular alone irri- 
table. Her epilepsies occurred three or four times or oftener in the 
day, sometimes not so often. 

The night before she died, she became conscious of the presence of 
a candle in the room by its light, but she could not distinguish ob- 
jects. Her intellects never failed; they remained good to the last, 
excepting that sort of indifference and dulness which always attends 
a long sickness and solitude. 

Her bladder at various times during my attendance continued irri- 
table, but for a few weeks before she died she ceased to complain of 
it. About the middle of September it was ascertained that the inter- 
ruption to her menses proceeded from pregnancy. 

By a very gradual process she approached her last moment, be- 
coming weaker and weaker, until life was finally extinguished in the 
epileptic paroxysm of the evening of the 19th. 

Autopsy on the evening of the 20th, twenty hours after death — 
present, Drs. Parrish and Pancoast. 

Exterior aspect, no putrefaction, countenance placid; middle ma- 
rasmus; no settling of blood in face. 

Head. Scalp bled freely on being cut across from ear to ear. Bones 
of middling thickness. 

Membranes. Dura mater of healthy colour and texture, but drier 
than usual along the middle line of the head; for half an inch or an 
inch from longitudinal sinus, on either side an unusual number of gra- 
nular bodies like the glands of Pacchioni, and supposed to be so, they 
pitted deeply the bones; in the sinus they were not unusually abun- 
dant or large. Arachnoidea and pia mater healthy, but they also 
seemed half dried, and the vessels of the pia mater were not unusually 
turgid; indeed they were rather collapsed. These membranes adhered 
very closely to one another, there being no sub-arachnoid effusion; 



Horner on the Nervous System. 61 

they also adhered to the dura mater along the longitudinal sinus more 
than usual, seeming to stick to it. 

The texture of the cerebrum was healthy, except that it seemed 
rather more collapsed and flaccid than usual. Its ventricles contain- 
ed together six ounces of a clear transparent serum, and were very 
much distended by it, the corpus collosum being lifted up considera- 
bly from the fornix, and the septum so thin that it was almost torn. 
The fornix adhered more than usual to the velum interpositum, and 
the latter was turbid or opaque where it passes into the ventricles. 
The ventricles communicated freely. No thickening of their arach- 
noidea was perceptible, nor distention of their vessels. 

Cerebellum. It was universally very flaccid, so that it could not 
retain its shape, but flattened itself by its own weight. On the un- 
der surface of its crus of the left side, there was a flattened oval 
tumour which originated from the crus, and had grown to the size of 
a hen's egg, extending itself forwards upon the side of the pons, and 
flattening it in. This tumour consisted in a congeries of cells of va- 
rious sizes, the walls of which were in a semi-cartilaginous state, and 
some of them containing serum, others a tuberculous-like matter, and 
others again a red spongy bloody matter. The most familiar compari- 
son of it is with the ovarium in the beginning of its cellular dropsies. 
This tumour had raised up in its development a part of the lateral 
substance of the cerebellum and the corresponding pia mater and 
arachnoidea; its first aspect was more like a cyst than any thing else 
on the side next to the crus of the cerebellum. 

The tumour had disturbed the position of all the nerves, from the 
fourth to the ninth inclusively, because in its development they had 
to pass along its under surface, and were both displaced and stretch- 
ed by the circuit they had to perform. The trigeminus was absolutely 
torn off except a few filaments, from the attachment of its root at the 
pons, and was there almost absorbed ; and what remained of its fila- 
ments were separated and pressed into a flat fasciculus. The medulla 
oblongata was pushed to the right side by this tumour, and bent. 

Thorax. Pleurae. Adhesions between right superior lobe and tho- 
rax; in other respects healthy. 

Lungs. Generally sound and healthy; settling of blood at their pos- 
terior parts. Right superior lobe contained half a dozen separated 
tubercles, the largest six or eight lines in diameter. They were of that 
dry, crumbling, cheese-like kind, which look like old crude tubercles 
aborted, and which are not attended with derangement of the contigu- 
ous pulmonary structure, but merely push it aside, Heart. Natural 
size, firm and health v. 



62 Dickson on the Contagious Nature of Dengue. 

Abdomen. Peritoneum healthy. Stomach, mucous coat empty, and 
of a sienna colour, excepting about the antrum pylori, where it was 
more of a pink colour. Small intestines healthy. Large intestines 
healthy; contained but little flatus, but filled with hard, dry compact- 
ed faeces, which extended itself for some inches into ileum. 

The uterus was up to the umbilicus, had pushed up the intestines, 
and was next to the abdominal parietes, triangular, and contained a 
foetus of about six months, laying across the abdomen, the head to 
the left corner, and the buttocks to the right corner. The collection 
of faeces seemed to have arisen from the uterus pressing on the rec- 
tum, as her common position was on the back. 



Art. V. On the Contagious Nature of Dengue. By S. H. Dickson, 
M. D. Professor of the Institutes and Practice of Medicine in the 
Medical College of South Carolina. 

IN my paper on Dengue, published in the November (1828) num- 
ber of this Journal, I advanced the opinion that it propagated itself, 
as well by a contagious influence as by an epidemic distemperature 
of the air. It seems that the majority of the writers who have noticed 
it have been disposed to deny its contagiousness. This question per- 
haps deserves further examination, and must be decided ultimately 
by a reference to facts. 

I cannot help thinking it somewhat singular, that in most of the 
essays alluded to, the circumstances offered as proving the epidemic 
prevalence of the disease, are regarded as disproving its contagious 
power. But no one at all conversant with the history of disease, can 
entertain a doubt of the strong tendency of a great number of mala- 
dies confessedly contagious, to become epidemic also; small-pox, 
measles, hooping-cough, all afford familiar illustrations of this prin- 
ciple. To these we may add the plague and typhus, which, if conta- 
gious, do not merely confine themselves to this mode of transmission 
and extension. I did not by any means deny, but rather dwelt upon 
the very great rapidity with which this singular affection showed it- 
self in different and distant parts of our city, which indeed seemed 
to me totally inconsistent with its exclusive communication from one 
subject to another by immediate contact or near approach. 

What was the source of this disease ? Whence its origin ? How 
was it introduced among us ? Were there any circumstances common 



Dickson on the Contagious Nature of Dengue. 63 

to the several places in which it made its appearance, by the agency 
of which we may account for its production ? 

We hear of it in Bengal in 1825. It cannot have been transported 
directly across the ocean, because of the exhaustion of the material 
during the long voyage to America. A gradual extension of it, how- 
ever, from point to point takes place, and we find it, accordingly, 
after the silent progress of a year and more, among the islands of the 
Caribbean Sea, in the autumn of 1827$ successively affecting these 
islands during the winter, it reaches Cuba in the spring of 1828, from 
whence, in June and July, it obtains easy access to Charleston, New 
Orleans, Vera Cruz, and Carthagena. In each of these cities it is ob- 
viously and in common opinion attributable to contagion, and is re- 
garded as imported from some position in which it was known pre- 
viously to exist. But physicians, scientific men, dispose of this view 
of the matter by the allegation, undoubtedly true, that the disease, 
when introduced, spreads itself by epidemic influence! But thus 
spreads on certain occasions variola, thus measles, and hooping- 
cough, after being unequivocally imported in a known and obvious 
mode. 

It is a matter of acknowledged difficulty to prove to absolute de- 
monstration, the contagious nature of any form of disease which is 
not capable of being communicated by inoculation; this is the expe- 
rimentum crucis, which, when it can be applied, puts the question 
fairly to rest. Few physicians, however, if any, will deny that there 
are cases in which the contagious virus is impalpable, and diffuses it- 
self immediately when generated, and eliminated throughout the sur- 
rounding atmosphere, so that its presence is not cognizable by the 
senses. In instances such as these, an attentive observation of all 
the circumstances of their origin, history, and progress, offers us the 
only means of arriving at a probable conclusion concerning their na- 
ture and properties. Rational probability, indeed, is the utmost that 
we can here attain, and an ingenious caviller may always succeed in 
throwing in our way objections and difficulties which shall oppose 
themselves to any positive decision of the point in dispute. Thus the 
contagiousness of several shapes of pestilence, of plague, of typhus, 
and even of rubeola and pertussis, has been and still is denied by cer- 
tain medical sceptics. But the preponderence of the evidence in fa- 
vour of their possession of the alledged quality, is such as to have sa- 
tisfied an infinite majority of the profession, and to amount to a very 
reasonable degree of certainty. 

In all such discussions, the first step to be taken is to decide upon 
the relative value of negative and affirmative statements, and here I 



64 Dickson on the Contagious Nature of Dengue. 

would lay it down as an absolute rule, as Haller has done in phi- 
losophyzing upon physiological experiments and deductions, that ne- 
gative observations are entitled to little or no weight, when in oppo- 
sition to positive assertions. If, for example, a very few instances 
were brought forward, upon creditable testimony, of the spread of 
any infection in certain specified communities, numbers would be of 
no further value than this, that they should, by diversity of position 
and circumstance, obviate the suspicion of a local cause common to 
all affected. Suppose it to be declared that a certain malady being 
introduced into five such communities had spread itself among them, 
seizing a few, many, or all within its sphere, it would be to no pur- 
pose to reply to the inference of its contagiousness drawn from this 
statement, that in twenty, fifty, or one hundred other such instances 
of introduction, it had failed to occasion any such extension. 

Contagion is, perhaps, of all the morbid agents which produce dis- 
ease in the animal constitution the weakest, and requires the greatest 
number and variety of favouring circumstances to ensure its disturb- 
ing impression. On the other hand, that which we allude to in the 
old phrase of Sydenham, as "the epidemic constitution of the air," 
is vastly the most powerful and pervasive. Every physician has 
failed occasionally in transmitting small-pox and vaccine by the most 
careful inoculation. But when the former becomes epidemic, it is 
known to affect persons who have been most carefully secluded, and 
guarded with the utmost nicety against all imaginable modes of acci- 
dental approach either to diseased subjects or any shape of fomites. 

The sphere of action of contagion is contracted within narrow 
limits; Haygarth, O'Ryan, and others do not allow of its radiation 
to a greater extent than a few feet, say three or four. Russell pre- 
scribed for the plague from his window, and even approached within 
four feet of the sick, with safety. Like all other morbid agents, it 
requires, to produce its evil influence, a certain degree of concentra- 
tion, which is obviated readily, whether of purpose or incidentally, 
by ordinary cleanliness and free ventilation; the former is operative 
by the avoidance of all accumulation of deleterious secretions, the 
latter by their solution, diffusion, and dispersion in the air. Even 
Prussic acid must be administered in an obvious dose, or in an intense 
state of concentration, to kill; and malaria in all its modifications is 
more dangerous in calms than in stormy weather. The difference 
between a common poison and a specific virus is, however, remark- 
able in the modes in which they are severally affected by this dilu- 
tion or avoidance of concentration. We modify by dilution the in- 
tensity qr degree of effect of a poison, and it is by such management 



Dickson on the Contagious Nature of Dengue, 65 

that we obtain salutary or remedial influences from many poisons. 
By similar dilution we cannot modify, though we may prevent, the 
effect of a virus; the degree or intensity of whose action we can only 
diminish by altering the condition or predisposition of the recipient. 
Thus the one-hundredth part of a drop of variolous or vaccine matter, 
will as thoroughly pervade the system, and as forcibly and perma- 
nently impress the constitution, as any larger amount of the same 
agents. 

Further, when we take into view the general, nay, we might say with 
propriety, the universal absence or negation of predisposition to con- 
tagious disease, and the so frequent want of susceptibility of its in- 
fluence, we shall rather wonder that such diseases spread themselves 
so often and so far as they do, than that they should be confined with- 
in certain observable limits both as to the extent of transmission and 
number of subjects. 

Epidemics depend upon and owe their spread to a cause diffus- 
ed through the air of any region, and deteriorating in some obscure 
way the purity of the atmosphere, which assumes itself a poison- 
ous power, and becomes capable of generating in living bodies sur- 
rounded by it a predisposition to and preparation for a specific con- 
dition of disease: this " epidemic constitution of the air" is then 
both a predisposing and exciting cause. Yet even epidemics, varied 
and powerful as they are in their influences, fail to affect numerous 
individuals within the spheres of their prevalence, either from origi- 
nal and opposed peculiarities of habit, or from engrossing, though it 
may be transient, conditions of body. Now contagion is a mere ex- 
citing cause, which, in affecting a healthy individual, has to contend 
not only with occasional want or deficiency of susceptibility, but also 
with almost universal absence of predisposition, which alone may be 
said to constitute a triple shield of defence. It depends, moreover, 
for the efficiency of its application upon near approach to its source, 
and upon a certain degree of concentration. These considerations 
offer abundant and satisfactory explanation of the failure of contagions, 
for the most part, to spread themselves in country places and in thinly 
populated neighbourhoods. Let it be regarded then as proof of igno- 
rance and presumption, to put on the common air of triumph in sug- 
gesting the question, " Why Dengue, being contagious, did not ex- 
tend itself over the whole surface of our continent. " 

It is usually a difficult task to point out the precise source and 
origin of any form of disease, yet the difficulties are not in all cases 
insurmountable. With respect to what are called general epidemics, 
the attempt has been notoriously futile. Not so, however, in the in- 

No. VII.— May, 1829. 9 



66 Dickson on the Contagious Nature of Dengue. 

stance of local epidemics, among which Dengue, if its contagious na- 
ture be denied, must of course be ranked. These are always limit- 
ed to particular season and temperature, as pneumonia typhoides, or 
to certain localities and circumstances of soil and surface conjointly 
with season and temperature, as bilious remittent, dysentery, and 
yellow fever; or to particular and cognizable alternation of conditions 
of the atmosphere, shown by the thermometer, hygrometer, and ba- 
rometer, of which catarrhs and pleurisies, &c. furnish exemplifica- 
tions. But Dengue has in its brief history shown no correspondence 
with any of these, being neither limited by season of the year nor 
locality, nor any cognizable atmospheric changes. 

Dr. Osgood of Havanna, has suggested that its cause and origin 
are identical with those of yellow fever, and such an opinion from 
authority so respectable, merits a deliberate reply. I would present 
the following discrepancies as sufficient to remove all suspicion of 
any relation or connexion between the two diseases. 

Yellow fever in Charleston occurs only in the autumnal months, 
prevailing in August, September, and October. I have not known 
of a case earlier than the 25th of July. Few have ever appeared in 
that month. It is the disease of strangers, occasionally attacking na- 
tive children. I will not absolutely deny that it has assailed a native 
adult or an old resident; but such instances are rare in the extreme, 
so extraordinary indeed, as scarcely to deserve being noted as ex- 
ceptions. They are more infrequent than second invasions of mea- 
sles or small-pox. It has never been known to assail an African 
negro. It never extends itself into the surrounding country, and 
notoriously respects particular elevated, airy, and salubrious spots in 
the city and suburbs. 

Dengue made its appearance here in June, and spent its force be- 
fore the end of July. It attacked promiscuously native adults, old 
residents, strangers, and children; and negroes, whether natives or 
Africans. It spread, as I will hereafter show, in the neighbouring 
country, and allowed no exemption to any location of town or subur- 
ban residence. 

I conclude this brief essay by a plain recital of certain facts which 
seem to me to afford satisfactory evidence in the power of Dengue to 
spread itself by contagion. I give the history of its introduction into 
our city in the very words of the two gentlemen who first met with it, 
concerning the weight and value of their testimony, there can be no 
necessity for a single remark from me. 

The first note subjoined, is from my friend and colleague, Di\ 
Thomas G. Prioleau, who writes as follows: — 



Dickson on the Contagious Nature of Dengue. 67 

*? Dear Sir — The first case of Dengue which I saw last summer, was on the 
10th of June, in a negro fellow belonging to Mr. S. Burger. He was labouring 
under high fever, and suffering the most distressing pains in the head, back, 
breast, legs, and arms, particularly in one hand. His attack two hours before 
was sudden, and while on board of the brig Emmeline. The captain of the 
brig, who was a few days before from the Havanna and the Matanzas, mention- 
ed to Mr. Burger that he had been sick with the Dengue a short time before 
leaving port, and that it was the same disease his fellow now had. 

*' The history of the case was this: soon after the arrival of the vessel here, 
from particular circumstances the crew were discharged, and this fellow sent 
on board of her to clean and take care of her. He remained on board three or four 
days, and at night slept on deck or in the cabin; she was neither offensive nor 
filthy from his account. 

" On the third day he was convalescent. The vessel within a day or two 
was sent up to Knox and Pritchard's wharf, and Mr. Kirkwood, a shipwright, 
was engaged to work on her; his residence was within one hundred yards of 
the place at which she lay. On the 23d, one of his children who had been 
playing on the wharf sickened, and on the next day another was taken ill. On 
the 30th, Mrs. Kirkwood, and Mr. K. himself on the first of July. 

" From the 20th of June to the 1st of July, there were several cases of the 
disease in that neighbourhood, both in families and among the negroes. From 
this spot it appeared to spread as from a centre. On the 1st of July I mention- 
ed most of these circumstances to the Medical Society, and understood from the 
members present, that neither had seen a case of the disease. Soon after, it 
spread rapidly through every part of the city. 

"lam yours, &c. 

"THOMAS G. PRIOLEAU." 

On the same subject Dr. Philip G. Prioleau writes thus: — 

" Dear Sir — In reply to your note requesting me to state the circumstances 
of the first occurrence of Dengue under my care, and its mode of introduction 
into our city, I with pleasure give you the following facts. 

"The first cases of Dengue which came under my care, were in the family 
of Captain J. Wellsman, in Church street, two doors south of Tradd street. 
Two of his daughters were smartly attacked with the disease on the 1st of July. 
On the 2d, his son was taken down; in three or four days another daughter, and 
in a short time after it extended to the rest of the family. Upon inquiry, I found 
that Captain W. had arrived in Charleston on the 31st of May, after a passage 
of five days from Havanna, where the Dengue then raged; that he was attack- 
ed with the disease the day before he sailed, and was sick when he arrived here. 
Mrs. Wellsman was taken on the 20th of June, and was suffering under its 
rheumatic effects when I was called to see the children on the 1st of July, as 
above stated. 

" With great regard, yours, &c. 

" PHILIP GENDRON PRIOLEAU." 

I shall not offer a word of commentary upon the lucid and positive 
statements contained in the foregoing letters. They appear to me to 



6$ Dickson on the Contagious Nature of Dengue. 

establish beyond controversy the fact that the Dengue was imported, 
and point out the instruments of this importation. 

If further proof be wanting of the contagious nature of the malady 
under consideration, it will be found in its transmission by diseased 
subjects into communities and families situated far from the influence 
of our city atmosphere, and of course removed from the epidemic 
disposition which is acknowledged to have existed. 

Among many instances to this purport which might be detailed, 
on Charleston Neck and in various points in the country, I have se- 
lected two as abundantly sufficient for my present object. The par- 
ticulars of the first will be found well detailed in a note from a cleri- 
cal gentleman of great intelligence and extensive reading. It may 
be proper to premise that Haddril's Point is a high bluff, projecting 
into our harbour about four miles distant from Charleston, in a north- 
easterly direction, singularly noted for the unrivalled salubrity of its 
air. During the prevalence of our endemic fevers, Haddril's has, 
from time immemorial, proved a safe and agreeable retreat. 

"My Dear Sib — In compliance with your request, I beg leave to state such 
facts in relation to the Dengue as came within my personal experience or ob- 
servation. My family resided last summer at the village, Haddril's, but I spent 
my time principally in the city until July, when the above-mentioned disease 
became prevalent. 

" Being seized with its symptoms, I retired to the village, and remained 
there until I had recovered my health. No instance of the disease had occurred 
there previously, but a short time afterwards several persons were attacked. 
Not more than half the adults in the same house with me became subjects to 
the disorder, and their sickness did not commence until several weeks after 
my own. 

"A neighbour similarly situated with myself carried the disease from the 
city into his family, of which all the adult members became infected. 

" Another neighbour, who had not visited the city, was violently seized im- 
mediately after coming out of a close apartment where a negro was suffering 
under the complaint, which he had contracted in town. 

" In addition to the above statements, it may be proper that I should remark 
that most of the inhabitants of our village who did not go to the city during 
the prevalence of the disease, remained wholly unaffected; and that those who 
had it without being exposed to the city atmosphere suffered far less severely 
than others. 

"Your's, &c. A. W. LELAND." 

The second instance, (with which I shall conclude,) refers to a 
plantation lying south-west of Charleston, about three miles beyond 
Ashley River. I give the history as I received it from the family 
physician, Dr. J. A. Johnson. 



Dickinson's Case of Wound of the Femoral Jirtery. 69 

" Mr. B. Adams was the first of his family who was attacked with Dengue. 
About the first of August, Mr. A. with one of his negroes, had occasion to visit 
Charleston; about a week afterwards they were both taken ill. Mrs. A. who 
had not been to town, was next seized, after an interval of about a week. The 
disease then went regularly through the family, (a large one,) with the excep- 
tion of but two." 

A similar extension of it among the negroes took place, though not 
to a great extent. Dr. J. adds that there was an obvious difference 
in the degree of violence between the cases of those who had been 
exposed to city air and those who had not, the latter suffering more 
slightly. 

This distinction was indeed generally observed, yet it was not in- 
variable. Some very severe cases occurred under my own notice on 
the Neck and in the suburbs, among persons who had not exposed 
themselves by visiting the city. 

The importance of the subject will, I think, justify the minuteness 
of detail into which I have gone in the relation of the facts above set 
down. I offer the same apology for the use I have made of the names 
of those from whom I derived information ; it seemed to me that the 
value of my authorities would thus be better known and more fairly 
estimated. I have employed their very words, in order that I might 
avoid the danger of mingling my opinions and inferences with the 
plain recital of incidents, from which every one should be left to 
draw his own deductions. 

I now leave the question willingly to the candid and impartial de- 
cision of my professional brethren. 

Charleston, January, 1829. 



Art. VI.— 'Case of Wound of the Femoral Artery successfully treated. 
By William G. Dickinson, M. D. of Franklin, Tennessee. 

At ten P. M. on the night of the 25th March, 1828, I was called 
in haste to see Mr. James C. Hill, merchant, a young gentleman of 
moral habits and fine health, who it was said had been stabbed and 
was dying. I found him ten minutes after the reception of the in- 
jury, lying on his back, covered with blood, and with both hands 
holding the edges of the wound firmly in contact. The wound was 
a little below the external abdominal ring, and just exterior to the 
spermatic cord of the right side, and nearly in the direction of a line 
drawn from the upper portion of the symphysis pubis, to the inferior 



70 Dickinson's Case of Wound of the Femoral Jlrtery. 

spinous process of the ilium. A large tumour extended from the ilium 
to the pubes, and the right half of the scrotum was distended to four 
times its natural dimensions, of a dark purple colour. 

I relieved the patient from the necessity of closing the wound, by 
placing the forefinger of my left hand over it. At this moment, (the 
haemorrhage not being effectually restrained,) the blood flew to the 
distance of several feet. It was not known, at the time, with what 
instrument the wound had been inflicted, and although the external 
orifice did not exceed five-eighths of an inch in length, the frightful 
quantity of blood, in which he was literally drenched, together with 
what he had previously lost, the cold surface of his body, and a pulse 
scarcely perceptible, convinced me that he was not in a condition to 
sustain further loss. 

I was not satisfied what vessel had sustained the injury; the situa- 
tion of the wound, together with the great size of the tumour on its 
pubic side, and the enormous distention of the scrotum, seemed to 
indicate that it was the spermatic artery. It was not possible, how- 
ever, to ascertain the direction of the wound by examination, without 
imminently endangering the life of the patient; for although I com- 
manded the external haemorrhage, I was aware that it was not sup- 
pressed, as the tumour continued to enlarge and extend itself on all 
sides. This circumstance was in one respect a favourable indication, 
inasmuch as it went to prove that the wound did not extend into the 
cavity of the abdomen. 

Drs. R. H. Campbell and T. Stith having come to my assistance, 
I made an incision, two inches in length from the wound, towards 
the symphysis pubis and over the most prominent part of the tumour. 
After going as deep as prudence seemed to sanction, and finding no- 
thing but an injected cellular structure, another incision, three inches 
in length, was made towards the spinous process of the ilium, in the 
direction of Poupart's ligament. So soon as the skin and cellular 
tissue were divided by this incision, the blood gushed forth with con- 
siderable velocity. I instantly passed my finger into the opening, 
and guided by the warm jet of blood, placed it on the femoral artery. 
About one-third of the artery's circumference was divided directly 
at the point of its exit, from under Poupart's ligament. This liga- 
ment was also divided, at its lower margin, apparently to an extent 
equalling the breadth of the instrument by which the wound was in- 
flicted. 

The wound being cleansed, it was evident that the haemorrhage 
was completely controlled by the pressure of my finger: in fact, it 
was so entirely suppressed, that Dr. Stith proposed to confide the 



Dickinson's Case of Wound of the Femoral Jlrtery. 71 

case to compresses and a bandage. To secure the vessel conveniently, 
it was found necessary to make an incision an inch and a half in 
length, in the direction of the femoral artery. Constant pressure be- 
ing necessary to prevent a recurrence of haemorrhage, some difficulty 
was encountered in passing the ligature. It was, however, finally 
effected by a directory and needle, which last instrument was firmly 
grasped in a pair of small forceps. The ligature being divided, one 
portion was carried as high as possible, and firmly tied; the other as 
low as the detachments would permit, and also firmly tied. The 
ligatures used were of silk, in preference to the animal suggested by 
Dr. Stith. 

All pressure being removed, the wound neatly sponged and left 
exposed for some time, and no haemorrhage recurring, the parts were 
brought in contact and secured by adhesive strips, over which a com- 
press and bandage were applied. The patient's legs were flexed and 
well supported, and his situation rendered as comfortable as circum- 
stances would permit. 

He was left to repose at three o'clock A. M. after taking tinct. 
opii gutt. 30; pulse 95. He had taken during the operation ^ss. 
camph. tinct. opii and some undiluted spirit which he said was taste- 
less. 

26th. Slept none since the operation; complains of pains in different 
parts of the body, but more particularly in the knee and muscles of 
the leg of the right side; no appreciable difference in the temperature 
of the two extremities; pulse 92; at intervals during the day took a 
little chicken water, and at night a cup of tea; no pulsation in the 
leg, and in the evening rather cold; gentle friction ordered; at night 
took §ss. Epsom salts in three doses. At ten o'clock at night, slight 
pulsation at the internal ankle was perceptible to Dr. O'Bryan, who 
was with him. 

27th. Slept three hours during the night; salts operated well; felt 
relieved by their operation. Ten o'clock A. M. pulse 85, and quite 
perceptible at the ankle; still complains of pains in the joints and 
muscles of the right extremity; ordered friction and passive motion 
of the ankle and knee joints; a cup of tea for breakfast, and light 
soup at noon. Four o'clock P. M. pulse 96; too much company; slept 
half an hour in the evening. Eight o'clock, pulse 85; took a cup of 
tea; being restless, tinct. opii gutt. 30, were given at twelve o'clock. 

28th. Slept two and a half hours after taking the opiate; pulse this 
morning 80, and regular; ordered for breakfast tea and a little toast- 
ed bread. Six o'clock P. M. pulse 75. 

29th. Passed a restless night. At four o'clock A. M. took tinct 



72 Dickinson's Case of Wound of the Femoral Artery. 

opii gutt. 30, after which he slept two hours. Eight o'clock A. M. 
pulse 100. Ten o'clock, ordered salts, which operated well, and 
afforded considerable relief. Six o'clock P. M. pulse 80. Eight 
o'clock, wound examined; it had united throughout, except at the 
exit of the ligatures and the angle of junction of the incisions, at 
which point there was a suppurating surface, about an inch and a half 
long, and half an inch broad, presenting pus of a healthy character; 
the edges of the wound were drawn in contact by adhesive slips; or- 
dered tinct. opii gutt. 40, to be taken at eleven o'clock. 

SOth. Slept but little, notwithstanding the opiate. Six o'clock, 
pulse 100; ordered coffee for breakfast, and a little rice at noon; slept 
several hours during the day. Four o'clock P. M. pulse 84, and soft. 

31st. At ten o'clock last night took tinct. opii gutt. 30, but passed 
a restless night. At six o'clock this morning had a natural evacuation 
from his bowels. Eight o'clock, disposed to sleep; pulse 100, and 
vibrating; diet as yesterday; wound looks well. 

April 1st. Rested better last night than he has done sinGe the ac- 
cident; took no opiate. Six o'clock A. M. pulse 80, and soft; took 
Epsom salts ^ss. which operated well; diet as yesterday; the wound 
looks well, but the pus a little tinged with blood. 

2d. At one o'clock A. M. took tinct. opii gutt. 25, in part to relieve 
a disposition to cough, which has become troublesome, and irritates 
the wound; the pus considerably tinged with blood, but the wound 
healthy in appearance; pulse 100, with some heat of the skin; diet as 
usual. 

From this period his improvement was gradual, until the 11th, 
when the lower ligature came away; the other ligature remained un- 
til the 18th, when it was withdrawn without difficulty. The wound 
presented a healthy aspect until the 27th, at which time its appear- 
ance was irritable, and the discharge unhealthy. This change was 
produced by circumstances of an exciting and disagreeable nature. 
Ordered a more nourishing diet. From this to the 31st the improve- 
ment was rapid, at which time the wound was entirely cicatrized. 

Mr. Hill has since enjoyed uninterrupted health, and experiences 
no inconvenience from the accident; and is actively engaged in his 
usual avocations. 

Franklin, Tennessee, Jan. 25, 1829- 



Togno on Endos?nose and Exosmose, 73 



Art. VII. — Experiments to prove the Existence of a Peculiar Physico- 
organic Action, inherent in Animal Tissues, called Endosmose and 
Exosmose.* By Joseph Togno, M. D. 

A HE following experiments were suggested by the perusal of Dr. 
Dutrochet's interesting memoir "On the Intimate Structure of 
Animals and Vegetables, and on their Motility," and especially by 
the chapter entitled "Observations and Experiments on the Tur- 
gid State." The actions of endosmose and exosmose seemed to throw 
so much light upon the process of absorption and secretion, especially 
the exhalation of fluids into cavities constituting dropsy, that I felt 
desirous of repeating the experiments of Dr. Dutrochet, and of ex- 
tending them to the membranes which are the seat of dropsy. 

Absorption is generally divided into external and internal. 

The former, according to Cruickshanks, Hewson, Hedwig, &c. 
is performed by a set of vessels arising immediately from the free 
surface of the digestive mucous membrane, the orifices of which they 
assert having distinctly observed; whilst equally good authorities, as 
Rudolphi, Meckel, Cuvier, and others, affirm that they originate 
from the soft and spongy substance which covers the interior of this 
mucous membrane, and which is capable of imbibition. 

Of the formation of the orifices of the chyliferous vessels we are 
at present ignorant, as well as in what the action of absorption 
consists. We know, however, these vessels must possess "a pecu- 
liar action," by virtue of which they take from the chyme the elements 
needful for the formation of a new fluid, chyle; but in what this "pe- 
culiar action" consists no physiologist has ever been able to explain 
satisfactorily. It has been ascribed by some to the compression of the 
intestinal parietes, which, by mechanical pressure, forces the chyle 
into the gaping orifices of the chyliferous vessels; by others to the ca- 
pillary attraction of the mouths of these vessels; again, by others, to a 
special sensibility together with an organic contractility of the absorb- 
ing orifices, &c. Avery curious circumstance, worthy of being noticed 
in this place, and which was first observed by Magendie, is that this 
absorption continues for some time after death, showing that the ac- 
tion of absorption does not entirely depend upon the laws of vitality, 
but on a physical action independent, to a certain degree, of vitality. 

Recently, Messrs. Ribes and Magendie have revived the opinion 

* Endosmose, an impulsion or action inwardly, from wcfto, inward; and «t^o?, 
impulse; and exosmose, the reverse action, from sf, out; and torpos, impulse. 
No. VIL— May, 1829. 10 



74 Togno on Endosmose and Exosmose. 

of the ancients, that liquids are absorbed by the mesenteric veins, 
but in what manner, they have never pretended to explain. 

These considerations on external absorption leave room to suppose 
that there is yet some mysterious action in this function, of which 
we are entirely ignorant. 

We are still less acquainted with internal absorption; the greatest 
obscurity existing as well in reference to its phenomena as to its me- 
chanism.* 

The lymphatics are distributed into two sets in almost every organ, 
the one superficial, the other deep-seated. Their mode of origin is un- 
known. Some anatomists admit between these vessels and the arte- 
ries a direct communication; others think that they open by a gaping 
orifice on the surfaces and into the structure of the organs. Lie- 
berkuhn asserts that at their extremity is to be observed a small 
spongy vesicle, in which terminates an artery and a vein. This ob- 
servation seems to coincide with the mode of termination of the mu- 
cous membrane of the lungs, which terminates in small cells resem- 
bling a bunch of grapes, and the same structure is to be observed in 
the formation of the salivary glands, the liver, the pancreas, and fol- 
licles which are disseminated all over this mucous membrane, they 
being mere prolongations of this membrane, and all terminating in an 
infinite number of cul-de-sacs, the parietes of which are irrigated by 
very minute blood-vessels. It is in these cul-de-sacs that all secre- 
tions are produced. This structure of all secreting organs is parti- 
cularly worthy of our attention; for we shall find it to be a very im- 
portant clew to the discovery of the mode of function of all secretory 
organs, especially when we shall apply the principles to be deduced 
from the following experiments. 

The lymphatic ganglia are considered by Haller, Albinus, Hew- 
son, Meckel, &c. as being clusters of lymphatic vessels; Malpighi, 
Nuck, Hunter, and Cruickshanks assert that these are here inter- 
rupted by small cells. 

With respect to the mechanism of this function, M. Hutin, in his 
Manual of Physiology, says, "The mechanism of this function is 
rather inferred by the observation of its result, than by any positive 
knowledge we have of it; this function indeed is in itself inscrutable, 
so that we can only offer conjectures respecting it." 

All the hypotheses which have been imagined to account for the 
one, have also been applied to explain the other; but the only one 
in my estimation worthy of being referred to, is the passive imbibition 
by a kind of spongy substance, in which it is supposed these vessels 
arise, &c. 

* See Hutin's Physiology, p. 61 to 70. 



Togno on Endosmose and Exosmose. 75 

Malpighi considered the ganglia of these vessels to be so many 
little hearts, or active powers, placed at different distances along the 
course of these vessels, to excite the circulation of the lymph. They 
could possess this supposed power if they were hollow sacks, in which 
the action of endosmose and exosmose could take place, and then 
we might grant them this appellation of little hearts. 

With respect to venous absorption, many physiologists deny to the 
veins this property, and consider them as only taking up, or rather 
receiving in a passive manner, the remainder of the arterial blood 
through an uninterrupted continuation of tubes. But an examination 
of the capillary circulation of a frog, through a microscope, has con- 
vinced me that the capillary circulation is not performed in continuous 
tubes, as generally believed, but in the meshes of the cellular struc- 
ture, or parenchyma of the organs. Nevertheless, the experiments of 
Magendie establish beyond doubt venous absorption, and the manner 
in which he accounts for it, is that it occurs by a capillary attraction; 
but we are no wiser after this explanation. M. Fodera supposes this 
kind of action to be owing to a species of imbibition of the tissues, an 
idea which seems to me the most probable. 

Recently Messrs. Ribes, andLEURETandLAssMGNE, positively de- 
clare having perceived the free orifice of veins on the external surface 
of the intestines, and still more recently Messrs. Fohmann, Lauth, 
Jr. and Lippi have discovered numerous communications between 
the lymphatics and the veins, and by this communication they wish 
to account for the apparent absorbing power of these latter vessels. 
We shall only add to the various and very different observations 
already quoted, that Dr. Flandrin has observed absorption to occur 
through both the venous and lymphatic systems.* 

In venous, as in lymphatic absorption, the difficulty consists in ex- 
plaining satisfactorily its mechanism, because in both these systems the 
absorbent action, whatever it may be, must be the same, since the same 
end is attained in both, and both systems act on the same materials. 

As closely connected with the subject, I must be permitted to offer 
a few cursory observations on the secretions. 

Blumenbach ascribes the absolute cause of most secretions to the 
intimate structure of the secreting organs, and also to the parenchyma, 
which he thinks is possessed of a " vita propria," " a peculiar species 
of vitality distinct from the common vital powers of contractility, irri- 
tability, and sensibility. " This is to say what is not secretion, but does 
not explain either the structure of the secreting organ, or the action 
producing secretions ; nor are we any wiser after this explanation. 

* Journal des Progres, Vol. VII. 



76 Tog;no on Endosmose and Exosmose. 



o 



The same may be said almost of all the explanations advanced by 
different writers; I therefore shall dwell but slightly on them, and 
proceed to expose some of the views suggested to me by Dr. Du- 
trochet 

The principal opinions entertained respecting this function may be 
divided into the physical, chemical, and vital theories. 

1st. Physical theories.'— Boerhaave, Malpighi, Haller, &c. 
were of opinion that all humours primitively existed in the blood, and 
that the vessels diminished gradually in fit proportions to the size of 
the globules of that fluid. These considerations led them to believe 
that all secretions were the result of mechanical filiations. Other 
physiologists compare the secretory vessels to a roll of cotton, which, 
when plunged into a mixture, would only attract the fluid with 
which the cotton had been previously imbued. Dr. Fodera, from 
a series of experiments lately performed, was led to consider exhala- 
tion as a simple transudation, and absorption as an action of imbibi- 
tion. He ascribes these two phenomena to the capillarity of the tis- 
sues, and asks if it were possible to extend this explanation to folli- 
cular and glandular secretions. 

2d. Chemical theories — The supposed leaven of some ancient phy- 
siologists is too absurd to require notice. 

Berzelius, a great name in chemistry, explains secretions by an 
electric influence. Messrs. Prevost and Dumas assert that the se- 
creted fluids are the product of a galvanic power, caused by the glo- 
bules of the blood, which, according to them, represent or stand for 
so many galvanic plates in a state of action. In this respect the ob- 
servations of Dr. Fodera, who has remarked that a stream of electri- 
city excited transudations, favours very much the position of these 
celebrated experimenters. Still I believe they have fallen into an 
error in ascribing to the globules of the blood what really belongs to 
the vesicles or globules of the tissues of the organs. 

3d. Vital theory. — This theory originated with Stahl, and was sup- 
ported by Bordeu, by Barthez and Bichat. It supposes in every 
secretory organ a kind of digestive action; but we are entirely un- 
acquainted with this peculiar organic and vital elaboration; so that 
we are now just as far removed from a knowledge of the process as 
ever, and as ignorant of its nature. 

A word now on Dr. Dut rochet's views on this subject before giving 
my experiments. 

All the tissues or organs of animals are essentially composed of 
agglomerated, globular, or vesicular cells. This fact had been partially 
announced by Leuwenhoek, and not long ago confirmed by the re- 
peated microscopical observations of one of the most accurate ob- 



Togno on Endosmose and Exosmose. 77 

servers of our age, Dr. Milne Edwards. This great and luminous 
truth, that all tissues can be solved into globules, as an elementary 
form is so universal, and these elements or monads are every way so 
similar, that when observed with the microscope, it is difficult to dis- 
criminate parts of the brain from the liver or the tissue composing 
any other organ. This uniformity of elementary formation of the 
parenchyma of all the parts of organized bodies, proves that they 
differ only in the nature of the substances that the vesicular or glo- 
bular cells contain, and of which the organs are entirely composed; 
and according to Dr. Dutrochet, it is in these cells or vesicles that 
secretions occur, and they furnish the fluid proper to each organ, 
which fluid is probably transmitted by transudation into the excretory 
canals. Thus we see that according to this author the vesicular 
structure is the sine qua non of all secretory actions. By this 
vesicular formation of the tissues of our organs, we possess the indis- 
pensable and fundamental condition for the production of endosmose 
and exosmose, into which all the vital actions are to be resolved. 

It is well known also, that the fluids of the body are, like the so- 
lids, composed of globules, and hence they have in their intimate 
composition the elements of the solids, and may be considered also 
organized, without much violence to sound philosophy. The only 
difference is that in the former the globules are free and unconnect- 
ed, whilst in the latter or the solids, they are adherent and agglome- 
rated; so that the figurative appellation given to the blood by Dr. 
Broussais of " chair coulante," is no longer a metaphor, but a reality. 
Hence, if the blood of a person emaciated by sickness and abstinence 
be examined through the microscope, very few globules will be found; 
showing that they are always in the same proportion as the state of 
assimilation. 

Experiments — First Series. 

The intestines, cceca, and crops of two fowls killed the previous 
day, having been cleaned completely, the parts of the intestines be- 
ing each five inches long, were selected for the following experi- 
ments.* 

The substance experimented upon was gum arabic in solution, the 
proportions being gum arabic §j. — water 5vi. 

July 26th, 1828, 6 P. M.— Fahrenheit's thermometer ranged from 78° to 82°. 
— No. 1. Two of the coeca were less than one-half filled with gum arabic solu- 
tion, and ligatures firmly applied. 

* These experiments were performed in a cellar, the temperature above 
ground being too high. 



78 Togno on Endosmose and Exosmose. 

No. 2. Two crops were also half filled with the same solution, and ligatures 
firmly applied to prevent any liquid from escaping or entering through their 
natural openings. Both No. 1 and 2, were plunged into a basin of fresh river 
water, and permitted to remain all night undisturbed. 

No. 3. Two cceca, about four inches long, were filled with simple water, and 
a ligature firmly applied; they were then immersed in a solution of gum arabic. 

No. 4. Three pieces of intestines, perfectly empty, were tied at their extre- 
mities, and immersed in water. 

July 27th, 8 A. M. — Examined the preceding experiments, and found: — 
No. 1. The coeca were by this time full, indeed nearly turgid. This endosmose 
is even more active than that reported by Dr. Dutrochet. Being rather astonish- 
ed at this " turgid state," I was induced to examine the ligatures as well as the 
cceca, fearful of being deceived, but found every part perfectly tight. 

No. 2. The two crops were examined, and were nearly as turgid as the' two 
cceca placed in the same basin. The water of this basin was renewed. 

No. 3. The two cceca were perfectly empty of all their water. 

No. 4. The intestines had already introduced a thimbleful of water. 

The water in the vessel was renewed. 

July 27th, 6 P. M. — Fahr. 80°. — No. 1. Renewed the water in the vessel. 
The cceca continue turgid. 

No. 2. The crops are now very turgid; one, however, more than the other. 

No. 3. Dismissed as very satisfactory, having produced a very perfect in- 
stance of exosmose. 

No. 4. The intestines which were empty, are now more than one-third full. 
The water in the vessel again renewed. 

July 28th, 5 P. M— Fahr. 77°.— No. 1. The cceca less turgid. 

No. 2. The crops as turgid as ever; indeed rather more so. Renewed the 
water in the vessel. 

No. 4. Rather more turgid. 

July 29th, 11 A. M. — Fahr. 74°. — No. 1. The cceca have become flaccid, and 
the water has a putrid smell. Dismissed. 

No. 2. The two crops have attained their maximum of turgidity, but now 
begin to become flaccid. I opened them, and both their contents were putrid. 
The mucous membrane is beautifully detached from the other parts. 

Observations. — No. 1. Presents us with an example of endosmose 
continuing for nearly sixty hours, and after this period the inverse 
action or exosmose has taken place. 

No. 2. We observe in this experiment also, the same action of 
endosmose going on and arriving at an astonishing degree of turgidity, 
and then the opposite action, exosmose, to occur. 

No. 3. We observe in this experiment a contrary action to happen, 
that is exosmose, the denser liquid being without and the rarer with- 
in the organic tissue. This action has been very rapid, even beyond 
all expectation. 

No. 4. This experiment is no less astonishing. This tendency of 
the surrounding liquid to permeate the tissues and penetrate into an 



Togno on Endosmose and Exosmose. 79 

organ, even when there is no liquid at all, has been an object of spe- 
culation with Dr. Dutrochet.* 

Experiments — Second Series. 

July 28th, 4 P. M. — Fahr. 77°. — I killed a young- rat at two o'clock, and the 
skin being 1 stripped from the animal's back, I put some pure water in it, and 
closed it up firmly, the skin being* in its natural relative situation. When thus 
filled with water it weighed 500 grs. It was immersed in a solution of gum 
arabic, ^j. water, §v. 

July 29th, 7 P. M. — Fahr. 74°. — Weighed the rat's skin and contents, and 
found that it had lost 72 grs. I again replaced it in the same solution. 

July 30th, 7 A. M.— Fahr. 72°.— Weighed the rat's skin, and found that since 
last evening it has lost 24 grs. more, which, added to the 72 grs. lost the pre- 
vious day, make 96, being nearly a fifth of its weight, and one-third of the water 
which it contained. 

July 31st. — Fahr. 80°. — The rat's skin smells putrid. It was kept constantly 
in the same solution, which was wrong, because the mucilaginous qualities of 
the solution changed much. 

August 1st, A. M. — Fahr. 80°. — Weighed this morning the rat's skin, and 
found to weigh 500 grs. The water within being putrid, a partial endosmose 
has been produced instead of exosmose. 

Observations. — This experiment shows very forcibly the power of 
this action, as it occurred through the very thick skin of a rat. 

Experiments — Third Series A 

August 16th, 9 P. M. — Fahr. 74°. — No. 1. A crop containing gum arabic so- 
lution with ligatures applied to its natural orifices, and weighing 500 grs. was 
put in a vessel full of river water. 

No. 2. A ccecum containing gum arabic solution, with its orifice tied, and 
weighing 154 grs. was put in a separate vessel in pure water. 

No. 3. A ccecum containing gum arabic solution, and weighing 105 grs. was 
also put in water. 

No. 4. A ccecum containing water, its orifice firmly tied, and weighing 87 
grs. was put in gum arabic solution. 

No. 5. A ccecum containing gum arabic solution, and weighing 140 grs. was 
immersed in water in a separate vessel. 

August 17th, 8 A. M.*— Fahr. 74°.— No. 1. Weighs 552 grs. It has increased, 
in the space of 12 hours, 52 grs. 

No. 2. Weighs 269 grs. It has gained 115 grs. in the space of 12 hours, hav- 
ing produced, as well as the preceding experiment, a considerable endosmose. 

No. 3. Weighs 157 grs. and has of course augmented 52 grs. in 12 hours. 



* Dr. Samuel Jackson witnessed all the above experiments. 
f The object of this series was to repeat some of the preceding experiments. 
+ The water in which the cceca were immersed has been renewed this morn- 
ing. 



80 Togno on Endosmose and Exosmose. 

No. 4. Weighs 66 grs. There is a loss of 21 grs. 

No. 5. Weighs 261 grs. There is an increase of 121 grs. 

August 17th, 5 P. M.— Fahr. 75°.— No. 1. Weighs 574 grs. There is still a 
gain of 24 grs. more in the space of 9 hours. This crop is now very turgid, 
having taken 44 hours, or thereabouts, to produce this very considerable de- 
gree of turgescence. 

No. 2. Weighs 275 grs. There is an increase of 6 grs. in 9 hours. 

No. 3. Weighs 152 grs. having lost 5 grs. 

No. 4. Weighs 54 grs. There is a loss of 12 grs. more, and the ccecum is 
now quite empty. 

No. 5. Weighs 284 grs. The endosmose still continues, for in the space of 9 
hours there has been an increase of 23 grs. and the coecum is now very turgid. 

August 18th, 5 P. M.*— Fahr. 74°.— No. 1. Weighs 714 grs. There is an in- 
crease of 140 grs. more, in the space of 24 hours. 

No. 2. Weighs 277 grs. There is an augmentation of 2 grs. This ccecum has 
obtained its maximum of turgidity. 

No. 3. Weighs 151 grs. There is already exosmose, the endosmose having 
ceased. 

No. 4. This ccecum is now entirely empty. I opened it, and found it per- 
fectly sound, the ligature being very firm. This experiment has established 
exosmose beyond all matter of doubt. 

No. 5. Weighs 299 grs. There is a gain of 15 grs. more. Since the begin- 
ning of this experiment this ccecum has increased 159 grs. in about 56 hours, 
being more than one-half of its whole weight; but the liquid has increased at 
least three times its original quantity. This experiment is a successful and 
beautiful illustration of endosmose. This organ has now attained its maximum 
of turgidity, and in this state the organ resists a very considerable pressure of 
the finger without yielding. 

August 19th, 10 A. M. — Fahr. 70°. — No. 1. Still increases in size. It weighs 
1020 grs. it having increased 306 grs. in 17 hours; and since the beginning of 
the experiment it has augmented 520 grs. in the space of 72 hours, being now 
more than double. It is very turgid, and has reached its maximum. 

No. 2. Weighs 286 grs. There is still an increase of 9 grs. in 17 hours. How- 
ever, the endosmose is now nearly spent, and hence I dismiss it. The ccecum 
is very turgid, and endosmose very complete. 

No. 3. Endosmose has ceased, and exosmose now begins. 

No. 5. Weighs 296 grs. Endosmose has now stopped, and the contrary ac- 
tion, exosmose, is going on. Dismissed. 

Observations. —-No. I. presents a most striking case of endosmose. 
This action has occurred through the coats of the crop: the mucous, 
the muscular, and peritoneal coats, which are pretty thick. Had I 
fixed a tube to one of the orifices of this organ, I have no doubt that 
endosmose would have continued for some time, and the superfluous 

* The crop and cceca were not weighed in the morning, but the water in the 
vessels was renewed. 



[Togno on Endosmose and Exosmose, 81 

liquid would have ascended in the tube, and issued through its ori- 
fice.* 

Experiments — Fourth Series^ with Alkalies and Acids A 

August 22c?, 1 P. M. — Fahr. 72°. — No 1. A crop containing some alkaline 
solution, weighing 426 grs. was put in a separate vessel full of fresh water. 

No. 2. A coecum containing some alkaline solution, and weighing 90 grs, 
was put in water. 

No. 3. A crop containing water, and weighing 463 grs. was put in the alka- 
line solution. 

No. 4. A coecum containing water, and which weighed 243 grs. was also put 
in the alkaline solution. 

The four following experiments on acids were begun at four o'clock 
on the same day as the preceding. 

No. 5. A coecum containing diluted sulphuric acid, and weighing 148 grs. 
was immersed in water. 

No. 6. A coecum containing diluted sulphuric acid, weighing 98 grs. was put 
in water. 

No. 7. A coecum containing water, and weighing 174 grs. was put in diluted 
sulphuric acid. 

No. 8. A coecum containing water, and weighing 71 grs. was put in diluted 
sulphuric acid. 

August 22d, 8 P. M. — I weighed the coeca and crops employed in the pre- 
ceding experiments, and found them as follows: 

No. 1. Weighs 672 grs. being a gain of 246 grs. in seven hours. 

No. 2. Weighs 144 grs. An increase of 54 grs. in seven hours. 

No. 3. Weighs 488 grs. An increase of 25 grs. in seven hours. In this expe- 
riment we observe an endosmose, when we ought to have according to Dr. 
Dutrochet, an exosmose. I cannot account for this anomaly. 

No. 4. Weighs 191 grs. There is a loss of 52 grs. producing an exosmose, 
and this agrees with Dr. Dutrochet, as do the following. 

No. 5. Weighs 121 grs. There is a loss of 27 grs. in four hours. 

No. 6. Weighs 84 grs. There is a loss of 14 grs. in four hours. 

No. 7. Weighs 186 grs. There is a gain of 12 grs in four hours. 

No. 8. Weighs 82 grs. There is a gain of 1 1 grs. in four hours. 



* Gum arabic in solution is a very good substance for the production of these 
physico-organic actions. 

I have repeated the above experiments with milk. They tend to prove the 
same actions as a solution of gum arabic, but its effect is not so rapid as mu- 
cilage. 

f The solution employed in the following experiments was in the proportion 
of carbonate of potash, ^j., water, §xii. The diluted sulphuric acid used, was 
when applied to the tongue, very slightly pungent. 

No. VII.— May, 1829. 11 



82 Togno on Endosmose and Exosmose. 

August 23d, 9 A. M— No 1. Weighs 758 grs. There is an increase of 86 grs. 
in^thirteen hours. 

No. 2. Weighs 131 grs. There is a loss of 13 grs. in the space of thirteen 
hours. From an endosmose we have now an exosmose, and hence I dismiss it. 

No. 3. Weighs 435 grs. There is a loss of 53 grs. producing an exosmose, as 
ought to have been the case at first, but I know not to what cause to ascribe 
this discrepancy. 

No. 4. Weighs 173 grs. There is a loss of 18 grs. This experiment has pro- 
duced a perfect exosmose. 

No. 5. Weighs 113 grs. There is a loss of 8 grs. in the space of thirteen 
hours. We have in this experiment a very beautiful exosmose produced by the 
acid contained within the organ. 

No. 6. Weighs 76 grs. There is a loss of 8 grs. in this case as in the preced- 
ing experiment, No. 5, we have an exosmose, caused by the acid contained in 
the organ. 

No. 7. Weighs 162 grs. There is a loss of 24 grs. in thirteen hours. The 
action was at first endosmose, but now has changed, and will of course conti- 
nue as it always does. Dismissed. 

No. 8. Weighs 77 grs. There is a loss of 5 grs. There was during the first 
four hours of this experiment an evident endosmose, although weak, produced 
by the acid. 

August 2Uh, 10 A. M. — No 1. Weighs 954 grs. A gain of 196 grs. in thir- 
teen hours. It is now very turgid. It has increased, in forty-one hours, 528 grs. 
of water, which must have permeated the organ; this experiment is satisfactory 
as to the agency of the alkalies in producing endosmose. 

No. 3. Weighs 378 grs. being a loss of 57 grs. in thirteen hours, and altoge- 
ther of 85 grs. in forty-one hours. 

No. 4. Weighs 158 grs. a loss of 15 grs. and altogether of 85 grs. in forty- 
one hours, being about two-thirds of the whole weight of the liquid. 

No. 5. Weighs 107 grs. a loss of 5 grs. in thirteen hours, the action is now 
nearly at an end. There is a loss of 41 grains in forty-one hours. 

No. 6. Weighs 71 grs. a loss of 5 grs. The exosmose is nearly exhausted. 

Observations. — The general conclusion that we may deduce from 
the preceding experiments is, that when alkalies are contained in a 
hollow organ, endosmose is produced, when it is an acid, the reverse 
action, or exosmose occurs; and vice versa, when placed without the 
organ, the reverse action takes place.* 

Experiments — Fifth Series, on the Jlcids. 

August 23d, 5 P. M. — No. 1. A coecum containing water and weighing 103 
grs. was immersed in diluted sulphuric acid, rather stronger than that used in 
the preceding experiments. 



* The effects of acids, it should be observed in producing exosmose, was not 
quite as striking as Dr. Dutrochet's experiments led us to conclude. 



Togno on Endosmose and Exosmose. 83 

No. 2. A coecum containing diluted sulphuric acid, and weighing 117 grs. 
was put in water in a separate vessel. 

At 9 P. M. I weighed the above cceca and found them: 

No. 1. Weighing 110 grs. an increase of 7 grs. in four hours. 

No. 2. Weighs 96 grs. a loss of 21 grs. in four hours. This experiment, as 
well as the preceding, perfectly agrees with Dr Dutrochet's. 

August 2Uh, 10 A. M. — No. 1. Weighs 108, there being a loss of 2 grs. in 
thirteen hours. 

No. 2. Weighs 91 grs. being a loss of 5 grs. in thirteen hours. The exos- 
mose still continues, though feeble. 

At 5 P. M. weighed again the above cceca. 

No. 1. Weighs 108 grs. No change having occurred in seven hours. 

No. 2. Weighs 91 grs. No change has occurred. This appears rather sin- 
gular, but it must be ascribed to the diluted sulphuric acid being stronger than 
in the preceding experiments. 

August 25th, 9 A. M. — No. 1. Weighs 105 grs. The inverse action still con- 
tinues. This coecum was emptied, and a small quantity of solution of carbonate 
of potash put in, and immediately a slight ebullition occurred, indeed even 
stronger than in the diluted acid in which it had been immersed. This trial 
proves to conviction that the action of endosmose had caused the acid to pass 
into the organ through its tissues. 

No. 2. Weighs 91 grs. is quite stationary. This coecum was also emptied and 
the liquid which remained within was tested with an alkaline solution, but no 
acid was detected. The water in which the coecum had been immersed was also 
put to the same test, but no acid could be detected; the reason must be, be- 
cause I have changed this water several times, and the acid which issued into 
it must thus have been gradually removed. 

Observations. — These experiments evidently confirm the correct- 
ness of the preceding ones on the acids. 

I have repeated these experiments on the acids and alkalies over and 
over again, in order not to leave on my mind the least room to doubt 
that I might be mistaken, and I found that they all confirm each other, 

I have also performed some experiments on the sulphas ferri, in 
order to ascertain the effect or agency of the metallic salts in the pro- 
duction of endosmose and exosmose. I have not yet arrived at any 
certain conclusion with respect to the experiments performed on this 
salt. I shall not therefore relate them. 

If it be asked, " what utility can your experiments have in medi- 
cine ?" I shall simply answer, that if they establish a truth, it is in 
all cases an acquisition, a step forward made in the science of life, 
even should we now not find any immediate application. How many 
facts have been found useful in their application in practice, which, 
at first, were thought to have no immediate usefulness in the healing 
art ? But this is not entirely the case with respect to these experi- 
ments, as we shall now attempt to show. 



84 Togno on .Endosmose agid Exosmose. 

1st. Dr. Dutrochet observed that when the spermatic sacs of the 
snail, which resemble very much a retort, were immersed in water, 
this fluid would pass into them through the parietes and accumulate 
in such a quantity as to expel the sperm with violence, while at the 
same time the surrounding liquid would occupy the bulb of the retort- 
like vesicle. This action lasted as long as there was any sperm in 
them. He therefore concluded that in order to produce this physico- 
organic action, it was necessary that a fluid of a denser consistence 
should exist within these hollow organs, for no sooner was the sperm 
forced out of the organ by this unknown action than this current 
ceased. 

2d. He imitated this experiment with the cceca of fowls, and came 
to this conclusion: that it matters not what may be the size of the hol- 
low organ, or of how many membranes its parietes are composed, or 
what may be their relative situation with respect to each other. In 
all these cases the turgid state was equally produced, and called by 
Dr. D. endosmose. From this it is necessarily inferred that the in- 
dispensable condition for the production of this action was, that 
the organic parietes be disposed into a cavity, or have a globular or 
vesicular form, in order that the surrounding liquid should be forced 
within by this power, endosmose. 

3d. That by Dr. D. 's experiments, as well as mine, it has been 
demonstrated that the introduction of the rarer liquid into the hollow 
organ entirely depends upon the nature of the contained fluid being 
of a greater density than that in which the organ is immersed. 

4th. That as long as this contained liquid maintains its integrity 
of composition, the endosmose occurs ; but that as soon as it becomes 
putrid this action ceases, and a contrary action, called exosmose, 
takes place with great rapidity. 

5th. That by inverting the experiments, i. e. when the denser 
liquid of the two is the surrounding liquid, or is on the outside of the 
organ, the action is also inverse, and the liquid contained, or the 
rarer, passes out through the parietes, by the inverse action already 
called exosmose. 

6th. That when an alkaline solution is separated from the surround- 
ing fluid, say water, and contained in a hollow organ, there occurs a 
current which carries the water through the parietes of the said organ 
and renders it turgid to excess, that is, it produces endosmose. If, 
on the contrary, this organ be filled with water and the surrounding 
liquid be an alkaline solution, then the inverse action, exosmose, 
occurs. 

7th. That the preceding deductions are also applicable to the ef- 



Togno on Endosmose and Exosmose. S5 

fects or agency of the diluted acids; with this difference, however, 
that their action is precisely inverse of that of the alkalies.* 

8th. We have already established in proposition 3d, that the denser 
fluid induces the rarer liquid to form a current directed towards the 
former. The consideration of this fact has induced Dr. D. to sup- 
pose it, a priori, to be caused by electricity; it being well established 
that a difference in the density of two substances is productive of 
electricity. Moreover, it is also well ascertained that the electric 
fluid accelerates the transudation and evaporization of liquids. These 
facts evidently prove that this fluid does act on the molecules of liquids, 
and communicates to them impulsion. 

The galvanic fluid seems to possess even a greater influence on the 
molecules of liquids; this fact is said to be satisfactorily demonstrated 
by the curious experiments of Mr. Porret, published in the " Annales 
de Physique et de Chimie." I shall briefly relate his experiment. 

He separated a vase into two partitions by means of a bladder, and 
partly filled one of the partitions with water, and into the other intro- 
duced a few drops only; he then placed the positive pole in the parti- 
tion filled with water, and the negative in the other partition. The 
water passed through the parietes of the bladder, from the partition 
in which the positive pole was placed into that in which the negative 
was; that is to say, from the zinc, or less dense, to the copper, or more 
dense, and in this respect following the same law of density as endos- 
mose and exosmose. Thus these two actions are identified with the 
two poles of a galvanic pile or electricity. 

This experiment was slightly modified by Dr. D. and was perform- 
ed with a coecum, and he obtained the same result. Wherever the 
negative pole was placed, either within or without the coecum, there 
did the fluid flow through the parietes of this viscus. 

I have not yet had the opportunity of repeating this experiment, 
but from the great accuracy of Dr. Dutrochet, I do not doubt that the 
thing is as he states it. 

9th. Another observation seems to confirm this result, and to es- 
tablish even a greater similitude between endosmose and electricity. 

We see in propositions 6th and 7th that an alkaline solution is pro- 
ductive of an endosmose, when introduced into a hollow organ; but 
if an acid be placed therein, then an exosmose is caused. Now, if 
a salt with an alkaline base be submitted to the action of a galvanic 
pile, the salt is decomposed, and the alkali is transmitted to the ne- 

* These chemical agents were always used so weak or diluted as never to in- 
duce any alteration in the organic membranes employed in these experiments, 



86 Togno on Endosmose and Exosmose. 

gative pole and the acid to the positive. But we already know .that 
it is towards the negative pole that the current is directed, and that 
a similar current is also produced by alkalies; and hence the reason 
they both produce endosmose, and why the positive pole and the acids 
cause the same effect, exosmose. 

Thus we do not only see the similarity, but even the identity of 
action of endosmose and the poles of a galvanic pile, and that the im- 
pulse given to the liquid is owing to an electric current directed from 
the positive pole, (zinc, or acid, or less dense,) towards the negative, 
(copper, or alkali, or more dense,) and finally, it is to this action that 
the accumulation of liquids in -a hollow organ is owing, and soon pro- 
ducing and constituting the turgid state. Thus endosmose and ex- 
osmose entirely depend upon electricity. 

10th. Dr. D. compares the hollow organs which present either of 
these vital phenomena to Leyden jars, with permeable parietes, their 
interior being occupied by an electricity in an opposite state to that 
existing on their exterior, and that since the current of the liquid is 
always directed to the side negatively electrified, it follows that 
whenever the interior of these small Leyden jars are negatively elec- 
trified, endosmose occurs; their exterior, however, being positively 
electrified; and if these states of electricity be reversed, we shall 
have exosmose. 

I have already remarked that the tissues may be resolved into vesi- 
cles or globules, and that they are in fact made up of an agglomera- 
tion of these vesicles. Now every one of these vesicles, in their na- 
tural state, are filled with a liquid denser than the surrounding water, 
they consequently produce endosmose; and they therefore act as so 
many Leyden jars, negatively electrified within, and positively with- 
out. 

It results from this view of the subject, that the ccecum or crop of 
a fowl, made perfectly air-tight by ligatures, may be considered a 
hollow organ, the parietes of which are composed of an infinity of 
these Leyden jars, their interior being negative, and their exterior 
positive. But according to the laws of electricity, the coecum or crop 
may itself be considered as a larger Leyden jar, being in the same 
state of electricity. Dr. D. farther suggests that if a hollow sphere 
could be constructed with small agglomerated Leyden jars of glass, 
being all positive externally, and negative internally; this sphere 
would itself be a Leyden jar of the same kind. This explains beau- 
tifully why an empty coecum placed in water, permits that fluid to 
permeate and distend it, and thus produce a slight endosmose; and 
this action most satisfactorily explains the two cases of sudden dropsy, 



Togno on Endosmose and Exosmose. 87 

mentioned by Dr. Chapman in his clinical lectures; the one a gentle- 
man from Boston, the other from Virginia. Both became dropsical im- 
mediately after coming out of a bath; they had previously taken violent 
exercise; one of them took the warm, the other the cold bath; but the 
same result happened in both. They were at this time, to all intents 
and purposes, in the state of a Ley den jar, negative within, and po- 
sitive without; hence the endosmose, and their dropsy. The same 
may be said of a swollen drowned body, which has also been made 
turgid by the action of endosmose. My experiment on the skin of 
a rat, to a certain extent, tends to prove the same position, although 
it was an exosmose. 

11th. That when a ccecum containing a denser liquid is placed in 
a fluid less dense, this latter passes within that viscus; but there 
exists at the same time a feebler current from within outwards. 
This fact is particularly exemplified and demonstrated in one of my 
experiments on the sulphate of iron, in which the water surrounding 
the coecum contained some iron that evidently had oozed out by this 
feebler action, exosmose, while the coecum continued to become more 
and more turgid. 

12th. Thus it is demonstrated that there exists simultaneously two 
currents, endosmose and exosmose, both going on at the same time. 
Then, when we say that a substance produces endosmose, whenever 
put into a hollow organ, we mean to say that there exists a weaker 
current from within outwards, besides the one producing endosmose; 
so that endosmose and exosmose both exist at the same moment in 
the same organ, or rather in the vesicles composing each organ. To 
this simultaneous double action we may ascribe, in organized beings, 
the movements of composition and decomposition, or nutrition; inter- 
stitial absorption and serous exhalation, and external absorption; cuta- 
neous absorption and exhalation; the irrigation of the secretory or- 
gans by the blood, and the respective secretions of these organs, 
which secretions occur in each vesicle that constitutes chemical filters; 
in a word, all these functions are the result of this double movement 
or action, endosmose and exosmose. 

It is ascertained that electricity produced by the contact of two 
heterogeneous substances, gives rise to two electric currents passing 
in opposite directions. In the preceding experiments we have seen 
that two heterogeneous liquids nearly in contact, that is, simply se- 
parated by an organic membrane, produce also an electricity which 
is manifested by two opposite currents. A most important fact for 
the experimental philosopher, resulting from these experiments, is, 



88 Togno on Endosmose and Exosmose. 

the difference of force always attending these electric and opposite 
currents. 

13th. That many of the substances which are daily used as arti- 
cles of food, such as milk, the albumen, as well as the yelk of eggs, 
solutions of gelatine, gum-water, water sweetened with sugar, and 
most extractive principles of vegetables, and even opium, produce 
endosmose. Alcohol at 36° is one of the most powerful agents of 
endosmose; but when largely diluted with water, on the contrary, 
it produces exosmose. Now, this perfectly agrees with every days ob- 
servation and experience. We know that alcohol very much diluted, 
or given in any preparation into which this article enters in small 
quantity with water, is an excellent diaphoretic or diuretic, accord- 
ing as it may act, or rather according to the degree of temperature, 
whilst the immoderate use of ardent spirit, as is often practiced by la- 
bouring men in this country, produces inflammations or congestions, 
or extravasations, or effusions in the brain, lungs, spleen, liver, &c. 
The former mode of administration producing exosmose or diapho- 
resis; the latter mode, endosmose or congestion; hence the absurdity 
of the administration of alcohol in immoderate quantity whenever 
there exists already a congestion, as in typhus or typhoid diseases; 
and again, we are now able to account why diluted vegetable acids of 
every description are very beneficial in diarrhoea, and in fevers in 
which the gastro-intestinal canal is primitively affected, and in which 
the lesion and the fever, its symptom, are to be located. 

Dr. Chapman speaks in a very commendatory manner in his lec- 
tures, of the use of acids in some very stubborn cases of diarrhoea. 
The reason why vegetable acids are useful in these affections is be- 
cause they produce exosmose. 

14th. That a higher temperature augments the intensity of the 
endosmose; hence, my first series of experiments being performed 
when the thermometer was much higher than at any time when Dr. 
Dutrochet performed his, the endosmose in mine was proportionately 
more active. I may also have used my gum arabic solution rather 
stronger than Dr. D. which would also cause a more intense endos- 
mose. This fact perfectly agrees with the experiments of M. Bec- 
querel, in which he has proved the elevation of the temperature in- 
creased the intensity of the electric current. 

One more fact may be adduced in addition to those already cited, 
in order to prove that endosmose is owing to electricity. When a 
coecum is almost filled with the albumen of eggs, and immersed in 
water, it introduces this liquid into this viscus, and causes it to be- 



Togno on Endosmose and Exosmose* 89 



'& 



tome turgid. But on opening the coecum a few hours afterwards, the 
internal surface is found lined with a pseudo-membrane composed of 
coagulated albumen. Now, it is well known that the coagulation of 
albumen is one of the effects produced by the current of a voltaic 
battery. 

15th. It has been proved by the experiments of Dr. Dutrochet, 
that the life of nutrition of vegetables consists entirely in a movement 
or action of endosmose and exosmose; but these physico-organic ac- 
tions acknowledge for their principal cause, electricity; consequently, 
this agent or power is the principle of the life of nutrition of vegeta- 
bles. That absorption, exhalation, and secretions, constituting in 
fact the nutrition and life of the vegetable, are all performed through 
the agency of this principle. 

It is pretty generally known, that the justly celebrated Bichat, 
from a mature consideration of all organized bodies, came to the 
conclusion that the functions of life may be divided into two classes; 
the first he called animal life, or functions of relation; the second, 
organic life, or functions of nutrition, or vegetable life. This division 
is thought by many not rigorously exact. It has been especially 
criticised by Buisson, but not on a just foundation, and by Magendie 
in several notes of his edition of Bichat's work, "Sur la vie et la 
mort." Although we agree, to a certain extent, with the views of 
Magendie, that this division is "more brilliant than solid" in its de- 
tails, and when we minutely compare all animated beings, it is 
difficult to say where animal life terminates, and vegetable life 
begins, still we cannot help admiring the vast genius of Bichat in 
this generalisation. His division is sufficiently exact for our pur- 
pose, which is to show that the functions of nutrition in man are 
performed precisely by the same laws as the functions of nutri- 
tion in vegetables. But these laws in vegetables are endosmose 
and exosmose or electricity. We conclude, from the similarity of 
these functions in vegetables and animals, that they are in the latter 
also induced by the same principles; with this difference, however, 
that in the apparatus of nutrition of vegetables no nervous system 
has ever been positively demonstrated, while in the apparatus of nu- 
trition of animals we observe a system of nerves peculiar to it, I 
mean the sympathetic or ganglionic system of nerves. 

This system, in the higher orders of animals, unites every organ 
in close relation and sympathy, and" has a superintendence over all 
the functions and vital actions of the organs. 

16th. We have already remarked, that every tissue is formed by 

No. VII.— May, 1829. 12 



90 Togno on Endosmose and Exosmose. 

the agglomeration of vesicular bodies, containing substances some- 
times liquid, at others viscous and tenacious, and again solid, accord- 
ing to the different tissues into the composition of which these vesi- 
cles enter; they are irrigated on all sides by blood flowing in infi- 
nitely small vessels, and it is by a kind of infiltration that the blood 
penetrates into these vesicles, (the seat, as it will be demonstrated, 
of all functions,) and is therein modified. This vesicular state of the 
tissues in animals, as well as vegetables, is the indispensable condi- 
tion of endosmose and exosmose, and we shall see, that they are 
really possessed of this physico-organic action. 

The morbid state of the solids, called inflammation, is a condition 
familiar to every one. It is, also, well known, that the soft parts in 
this state become turgid, and that the fluids, either remote, or im- 
mediately surrounding, are, by an unknown cause, drawn, in great 
quantity, to the affected part. 

Here we are struck with the similarity of this phenomenon with 
endosmose; the effects of which, as we know, are manifested by the 
turgid state, and produced by a movement of adfluction. 

The arteries going to a part, thus circumstanced, augment in cali- 
ber, in order to conduct, and pour more blood into the tissues of the 
inflamed part. The veins which come from this part are dilated by 
the impulsion given to the blood, that this part, at this time, expels 
in greater abundance, and with more force. We have, then, two 
forces, the one drawing the fluids to the affected part — or adfluction; 
the other, expelling them with greater force than in the normal state 
— or impulsion. There is no doubt in my mind, that inflammation 
is a phenomenon of endosmose. 

This same phenomenon exists also in a normal state, but in a 
smaller degree of intensity. It is by this adfluction that blood is 
drawn into the minute capillaries, and it is to this same phenomenon 
of adfluxion, that is owing, the emptying of the arteries after death, 
when the heart has ceased to contract, and its impulsion, or vis a 
tergo, is at an end; and then the blood is found accumulated in the 
veins. This proves that the action of the heart ceases before the vi- 
tality of the tissues, (or rather of the component vesicles,) disappears, 
and explains the progression of the blood in the veins. 

It would also seem from this, that the supposed contraction of the 
capillaries does not exist; though I do not pretend to assert, that 
there are not several other causes which favour the progression of the 
venous blood; but I cannot agree, for instance, with Dr. Barry, that 
it is entirely owing to atmospheric pressure, and to the dilatation of 



Togno on Endosmose and Exosmose. 91 

the chest in respiration. To conclude, circulation is a phenomenon, 
having several causes for its accomplishment, namely, the contraction 
of the heart, and the endosmose occurring in the vesicles, by which 
the capillaries are surrounded, and which endosmose acts on the 
principle of a sucking and forcing pump, #-c. #-c. This action of en- 
dosmose in the capillaries, and causing the capillary circulation, is 
described by some French physiologists, as "a kind of vital aspira- 
tion or suction, which draws the blood into the parenchyma of the 
organs. " 

17th. The same reasoning holds good, and is applicable to the pro- 
gressive movement of the fluids contained in the chyliferous and lym- 
phatic vessels. The lymphatic ganglia, which are every where dis- 
persed on the route of these vessels, might be supposed, by a super- 
ficial observer, to hinder the progression of these fluids; on the con- 
trary, far from retarding their progress, they are placed here by na- 
ture, to favour, facilitate, and perform this great function 5 and this 
is again accomplished by endosmose. 

18th. Thus endosmose exists in a normal state in the organs of 
animals, of course inflammation is the exaggeration or exaltation of 
this physico-organic action, and has been called by Dr. D. an hyper- 
endosmose. Erectile turgidity is owing to the same cause, with 
this difference, that it happens as a normal action, modified by nerv- 
ous influence; but which normal action, if it were too often repeated, 
would become permanent, and produce a congestion. 

My observations have already extended to so great a length, that 
the practical application of this physico-organic action must remain 
for the present, at least, untouched by me; and I must refer my readers 
to the last thirty pages of Dr. Dutrochet's work, in which they will 
find some of the most valuable practical hints on the nature and cure 
of inflammation, on the modus operandi of medicines and dietetic 
substances, on the action of general and local blood-letting, &c. 
These thirty pages are pregnant with many truths, and they ought 
to be studied by every medical man. 

Philadelphia, March, 1829. 



92 Somervail on the Seat and Treatment of Erysipelas. 

Art. VIII. On the Seat and Treatment of Erysipelas. By Alexan- 
der Somervail, M. D. of Essex County, Virginia. 

IN the Bioliographical Notices of this Journal for November, 1828, 
there is one, entitled Observations on the Nature and Treatment of 
Erysipelas, by William Lawrence, Esq. F. R. S. &c. In one part of 
his treatment, he says, "the most powerful means of arresting the 
complaint, is by making incisions through the inflamed skin, and the 
subjacent adipose and cellular textures." This brought to remem- 
brance a similar proposition I made, in the close of the life of the 
late William Baynham, Surgeon, as recorded in the Philadelphia 
Journal of the Medical and Physical Sciences, for August, 1822. I 
there state the probability, that scarifications through the superficial 
vascular membrane, discovered by Mr. Baynham in 1779, would ar- 
rest the progress of erysipelas. 

Though I have never tried scarifications, yet the belief of the dis- 
ease being seated in this membrane, has influenced my management 
of those cases I have met with since, and I think with some advan- 
tage. Soon after the inflammation appears it spreads in one direction: 
in the face it often begins in a perpendicular line from the forehead, 
along the ridge of the nose to the chin: sometimes it moves towards 
the ear, and sometimes in the opposite direction. My intention has 
been to apply before the moving edge of the inflammation, something 
to alter the state of the yet uninflamed membrane, and prevent the 
accumulation of blood in its vessels, and excite the absorption of that 
already accumulated. 

In the first case that occurred, opodeldoc was applied before I saw 
the patient, with relief. I directed it in the next case that I saw all 
round the edges with success. In the summer of 1828, I met with a 
case in a poor emaciated woman, occasioned first from an extensive 
caries of part of both parietal bones, and the upper part of the occipital 
and frontal bones; then severe dysentery, and this followed by gene- 
ral anasarca and ascites, producing great emaciation and debility. 
Soon after these were removed, with every appearance of returning 
health, she was attacked with pain in one shoulder and neck, which 
she thought was swelled, and believed to be rheumatism, which she 
was often affected with; at the time she was unable to show the part 
affected, and I left a solution of pearl ashes and laudanum, to be ap- 
plied when she got help. On returning the second day, the affection 
had spread all over the back, and was evidently erysipelas. I direct- 
ed the mixture to be applied along the edges of the inflammation, but 



Somervail on the Seat and Treatment of Erysipelas. 93 

for want of assistance it was very partially done, yet with relief when 
applied. Some weeks after this it began again in the middle of the 
face, and was moving towards the ear; I directed the mixture before 
the moving edge, and the disease was arrested at once. Another 
case occurred in a man in good health; it spread all over the body, 
thighs, and arms; the mixture here gave great relief, and by the help 
of powerful purgatives the disease was removed; it returned, however, 
about two weeks afterwards, and was relieved as before. 

The preceding and attending fever is much increased and kept up 
by the pain of the inflammation; when the pain is mitigated, the fever 
diminishes, and when the pain is removed, the fever soon gives way. 
Mercurial ointment, and even oil, are said to mitigate the sufferings 
in this disease also. The fever always requires suitable remedies be- 
sides local applications, and no doubt in some, deep scarifications 
may be required, but no case of suppuration has fallen in my way for 
a long time. I have seen one well marked case in a negro. 

Since reading the notice of the method of cure by scarifications in 
the American Journal, I have found a copy of a letter from Mr. 
Baynham to his friend, Dr. Collignon, of Cambridge, containing a 
description of some preparations of the skin, to show this membrane, 
sent to him from London. This is dated May, 1779, the date toge- 
ther with some interlineations, written with his left hand, which he 
learned to use, in consequence of a hurt of his right arm, received 
in 1806. Of a part of this letter the following is a copy. 

" Nos. 10 and 11. Two portions of the common integuments of the 
leg, prepared to demonstrate the rete mucosum to be a vascular 
membrane, and not, as has been generally supposed, a mere deposi- 
tion of mucus. 

No. 10, is a piece preserved wet, with different sections through 
the cuticle and rete mucosum, two portions of which are peeled off 
from the cutis, and hang down towards the lower part of the prepa- 
ration. The first section to the right hand as you look towards the 
glass, is the cuticle and rete mucosum adhering to each other: apart 
of the cutis above, answering to the size of this, being exposed, and 
appearing of a whitish colour, with small granulated spots interspers- 
ed at regular distances throughout its substance. These specks I ap- 
prehend, are what are commonly meant by the miliary glands; or at 
least if they are not, it is my belief that each is a proper apparatus, 
designed for some secretion or other, though I will not take upon me 
to say what. In each of these the root of a hair lies buried, so that 
probably it is from thence the hair derives its nourishment; but be- 
sides this there are to every one of them, one, two, and sometimes three 



94 Somervail on the Seat and Treatment of Erysipelas. 

processes of the cuticle. I call them processes of the cuticle, because 

I have no better name to give them, but they may be the excretory 
ducts of these above-mentioned glandular spots, for aught I know to the 
contrary, as they plunge immediately into them through the rete rau- 
cosum, in which you will please to observe there are distinct and re- 
gular foraminse, answering to these processes, and which are no doubt 
occasioned by their passing through it from their origin, (if they are 
excretory tubes,) to get to the surface of the body, or vice versa, if 
considered merely as internal productions of the cuticle. The struc- 
ture of these granulated appearances I have been speaking of seems 
to be simply vascular, appearing to be convoluted vessels, when pre- 
pared for and viewed with a proper glass. 

The second piece of No. 10 is cuticle only, separated from the 
rete mucosum, the external surface of which is seen above, with a 
fine red blush upon it, and having a piece of blue paper insinuated 
between it and the true skin, in order to show it to greater advan- 
tage. In it are observable the foraminae I have just mentioned, and 
upon the cuticle below may be seen those processes answering to 
them, standing forth from the surface about a straw's breadth in 
length, smaller at the points than at their attachment to the cuticle, 
which may be called their base. "When viewed with a common mag- 
nifier, the vessels upon this wet portion of the rete mucosum may be 
distinctly seen; but to make them still more apparent, the piece No. 

II was prepared in the manner following: — 

The cuticle and rete mucosum, while the parts were yet wet, 
were separated from the cutis, but left attached to each other; then 
the parts were pinned out to dry, and the preparation afterwards put 
into spirit of turpentine. Here I might observe that the separation of 
the rete mucosum from the true skin, was always much easier done 
than between it and the cuticle, which was not effected without a 
good deal of care and attention. The lowermost thick part of this 
preparation is composed of cutis, cellular membrane, &c. from 
which was stripped the thin portion above, by which it is suspended, 
and which consists of rete mucosum and cuticle together, the drying 
having destroyed all distinction between them, and makes them ap- 
pear to be only one membrane, and from their thinness and transparency 
one would be led to believe that to be really the case: both membranes 
have however been adhering to one another, and dried in that state; 
the cuticle being next to the paper, and the red vascular appearance 
which is immediately exposed to view, is the internal surface of the 
rete mucosum, which in its natural situation, lies in contact with, and 
is connected to the true skin by its proper vessels, the order of whose 



Somervail on the Seat and Treatment of Erysipelas. 95 

ramification is parallel to the surface of the skin, and forms a most 
regular and beautiful reticular appearance, when viewed with a com- 
mon magnifying glass. From this mode of distribution it is evident, I 
think, that they are not perspiratory vessels, unless we admit the 
doctrine of transudation, and say the insensible perspiration is thrown 
off through their coats, which seems very improbable. It is extremely 
difficult to say from whence the vessels of the rete mucosum spring: 
they are most likely twigs sent off from some of the numerous cuta- 
neous arteries and veins, which must be necessarily broken in de- 
stroying the connexion between the two coverings. The circumstance 
of my having injected that part of the animal machine which had here- 
tofore been considered as inorganic, has made some little noise among 
the medical people here, some of whom have done me the honour of 
calling to satisfy their curiosity, by getting a sight of the prepara- 
tions. Amongst the learned of these gentlemen, were Messrs. J. 
Hunter and Cruikshanks, Drs. Jebb and Meckel, and some others; 
all of whom appeared to be convinced, and made me compliments 
&c. on the occasion." 

In answer to this, Dr. Collignon writes from Cambridge, 16th of 
May, 1779. 

" And now my good friend, give me leave to thank you for a most 
invaluable addition to my preparations, and which I assure you I 
prize highly, for your, as well as for their own sake. They have but 
one fault; they are too elegant and cast a shade over those I possessed 
before. I have no difficulty in agreeing to your determination about 
the rete mucosum, and I am satisfied you make me see it with my 
eyes; but I assure you the testimony of John Hunter and other vete- 
ran injectors is far preferable to mine." 

In Mr. Baynham's remarks on the margin of his copy of Cruik- 
shanks on the Absorbents, he calls this his membrane, in contradis- 
tinction to Cruikshanks', representing it, as I have done, in the ac- 
count of his life, in the Philadelphia Journal. 

Essex County, Virginia, Jan. 1829. 



96 Guild's Case of Epilepsy. 

Art. IX. Case of Epilepsy, successfully treated by the Operation of 
Trepanning. By James Guild, M. D. of Tuscaloosa, Alabama. 

1 HE subject of this case is Captain Stephen Elliott, a respectable 
citizen of this place, aged forty years, who had enjoyed perfect good 
health until August, 1827, at which time he was suddenly attacked 
with an alarming epileptic convulsion, which threatened immediate 
dissolution. Medical aid was speedily procured; a large quantity of 
blood being extracted, he was soon resuscitated, but remained in a 
comatose state a considerable time. His health from that time gra- 
dually declined, and he was the subject of epilepsy every one, 
two, or three weeks, as the exciting causes acted with more or less 
intensity. Great languor and lassitude succeeded, with an entire 
derangement of the healthy functions of the system, attended with 
an excruciating pain of the left side of the head; and an entire loss 
of the sight of the left eye, which produced intolerable anguish so 
long as he was the subject of epilepsy. 

I was of the opinion, as well as other medical attendants who saw 
him, that his complaint originated from a deranged state of the sto- 
mach and bowels, as there was considerable torpor of the alimentary 
canal; consequently, cathartics were administered to a considerable 
extent, accompanied with repeated copious blood-letting, with little 
or no benefit, with the exception of lessening the excitability of the 
system, thereby relieving the urgent symptoms for the time being. 
He was then put on a course of calomel for the purpose of producing 
ptyalism; that object being accomplished without the least amend- 
ment, we came to the conclusion that there was no other alternative 
but operating with the trephine, as the epileptic convulsions became 
more frequent, and such rapid destruction of his general health, that 
his life was despaired of. Accordingly, on the 10th of October, 1828, 
being fifteen months from the first occurrence of the convulsions, as- 
sisted by several medical gentlemen, a circular piece of bone was taken 
out immediately from that part of the head where the pain was most 
acute, being on the left side of the os frontis, one-eighth of an inch 
from the coronal suture. 

The bone was considerably diseased, rather of a carious and spongy 
nature, and somewhat thickened; as the trephine was going through 
the bone, the pain was so insufferable that we had to desist every 
one or two turnings of the instrument to prevent excessive nervous 
tremors. 

On the instrument's entering the diploe, the haemorrhage was so 



Guild's Case of Epilepsy. 97 

considerable as to produce alarm, inordinate hemorrhage from such a 
quarter being quite a novel occurrence; in a few minutes, however, 
the discharge of blood ceased, and there ensued a discharge of serum, 
which continued until suppuration took place. As soon as that effect 
was produced, a better state of things was observed; the health of 
the patient gradually improved; no recurrence of the convulsions; 
pain in the head disappearing. In thirty days the wound cicatrized, 
and he was discharged entirely cured, and now enjoys good health. 

There was no unnatural appearance of the dura mater, and the 
brain pulsated with the usual vigour, as in health. 

It will be perceived from the short and cursory detail given of 
the present case, that the cranium was the seat of disease, being 
thickened, thereby producing morbid irritation and congestion, and 
epilepsy. 

It cannot be thought for a moment that the subject of this case was 
relieved so much from merely taking away with the trephine the 
small piece of bone, as from the suppuration that ensued as a natural 
consequence; as a greater portion of the left side of the head was in 
a state of disease, even extending into the superior maxillary jaw 
bone. I feel warranted in saying that the diseases arising originally 
from the functions of the brain and its appurtenances have never re- 
ceived that attention which their importance demands. 

It has been, and is still the opinion of the medical world, that the 
trephine should never be resorted to in any case whatever, except 
where there is actually a depression of the cranium; but this gentle- 
man having never received a blow, or sustained any injury on that 
part of the head where the operation was performed, it follows that 
there are cases in which the trephine may be resorted to with suc- 
cess, other than those of depression of bone from violence; and I 
would not be much surprised if the trephine should hereafter be re- 
sorted to successfully in cases of lunacy, epilepsy, and a great many 
other affections of the head, that are suffered to linger out a loathsome 
and miserable existence. 

iVoJe.-— Some interesting cases of epilepsy cured by the use of the 
trephine, are related by Professor Dudley, in the Transylvania Jour- 
nal, Vol. I. See also this Journal, Vol. II. p. 489. — Ed. 

No. VII.— -May, 1829. 13 



98 Dakin on a Cutaneous Affection from Poison. 



Art. X. Remarks on a Cutaneous Affection, produced by certain 
Poisonous Vegetables. By It. Dakin, M. D. of Columbus, N. J. 

l^OME apology is, perhaps, necessary for offering the following re- 
marks to the profession ; but I do not recollect ever having seen a 
treatise upon the subject; and if authors on cutaneous affections have 
mentioned it, it is those to whose works others, perhaps like my- 
self, have not had access. Judging, however, from the remedial means 
generally resorted to, and which, according to my observation, rarely 
facilitates the cure, I am forced to believe, that this disagreeable af- 
fection has not received a due share of attention, probably from its 
seldom occurring in cities, and coming within the observation of me- 
dical writers. 

It is known among country people by the title of poison. The 
hands, feet, legs, face, and organs of generation, are the parts most 
usually affected. It is contracted by touching certain plants and 
shrubs, and not improbably, sometimes by inhaling, or swallow- 
ing with the saliva, the odour arising from them. Many suppose 
that breathing the smoke of the poisonous plants produces the 
disease. 

The shrubs most virulent are the poison oak, (Rhus toxicoden- 
dron,) and the poison ivy. The poison oak, or sumach, grows in 
marshy lands, from three to seven or eight feet in height, with a 
smooth stem, the branches projecting almost horizontally from near 
the top. A milky juice exudes from a fresh cut or broken branch. 

The ivy is a vine common I believe to most parts of the United 
States, growing luxuriantly in both low and high lands, running up 
stumps and trees, and attaching itself firmly to their bodies by innume- 
rable fibrous roots. Many branches proceed from the body of the vine 
containing stems three or four inches in length, with three leaves of 
an oblong shape and glossy green appearance on each. I once saw a 
boy, who was doubtful respecting the poisonous properties of this 
vine, rub several leaves on the back of his forearm. The burning 
eruption in a day or two produced a painful conviction, which dis- 
pelled his doubts. 

Some good meaning, mystical, marvellous physicians, or favoured 
ladies with knowledge inherent, say the bane will prove the best an- 
tidote, and hence advise the forbidden leaves to be eaten, both as a 
preventive and cure to the external disease. I have known the ex- 
periment tried, which resulted in an eruption, swelling, redness, 
and intolerable itching, around the verge of the anus. I was lately 



Dakin on a Cutaneous Affection from Poison. 99 

applied to by a mower, who was very much alarmed at the condition 
of his anus, which was very much swollen: an examination imme- 
diately satisfied me that it was nothing but poison. I directed cool- 
ing laxatives for two or three days, gave him a box of ointment to 
counteract the inflammation, and I heard no more of the case. 

After exposure, the eruption appears in from one to three days. 
The most prominent symptoms are, a slight itching and redness, fol- 
lowed by burning sensations, which soon become almost excruciating. 
The eruption, in most instances, is vesicular, about the size of a 
millet seed, and containing a transparent, thin, watery fluid, and so 
close together as to present a confluent mass. As the disease pro- 
gresses, the contents of the vesicles become yellow, and finally, in 
severe cases, pus, of the consistence and colour of cream, is dis- 
charged, and the sores then soon heal. If rubbing or scratching be in- 
dulged in, which it is almost impossible to avoid, the eruption spreads 
wherever the cuticle is abraded, The fluid will sometimes ooze from 
the vesicles, and run to some distance, the course of which will be 
marked by a red streak, and all the symptoms common to the ma- 
lady will follow, It is not dangerous, though very troublesome. If 
it be entrusted to poultices, lead water, cream, solution of galls, or 
mild soothing unguents, or lotions, or even to nature, it will gene- 
rally terminate in from five to ten days. 

The treatment which I have in every instance found successful, 
consists in blood-letting, cooling laxatives of neutral salts, and the 
following unguent as a local application: — R. Cupri sulph. ^\.', Pre- 
cip. mer. rub. 3L? Tereb. ven. 5"j-5 Axung. pore. §i. — M. ft. ungt. 

On the slightest admonition that the disease is contracted, I abrade 
the cuticle, or open the pimples, and apply a small quantity of the 
ointment, which occasions a slight smarting, but agreeable, compared 
with the tormenting sensations attendant on the affection. One or 
two applications with about twelve hours intervening between them, 
will arrest the inflammation, and in three or four days all marks of 
disease is generally obliterated. Venesection is rarely necessary, 
except the eyes, scrotum, or some important organ be concerned. 
The above ointment is most efficient in arresting the progress of the 
complaint if applied the day of its appearance; and though neglected 
for two, three, or four days, will generally give prompt relief. 

The affected parts should be kept cool, and the patient be ordered 
not to handle his body, without first washing his hands, after touching 
the sores, as he might thus unconsciously inoculate other parts. 

Why some possess a constitutional immunity from this disease, is 
a question that I believe has not been satisfactorily solved. Children 



100 Temple on Hydrorachitis. 

are susceptible whose parents never were poisoned. Many rub them- 
selves with the baneful leaves without the slightest injury. Mulattoes 
and negroes, light and dark complexions, appear equally susceptible. 
This susceptibility recedes as age advances. By simple contact with 
the vine or bush, we do not always contract the disease 5 but boys sub- 
ject to it, who run through meadows, get their feet scratched, and 
then touch the vine, generally pay dearly for their temerity. 

I should be pleased to have the question solved, why some handle 
with impunity what will so soon severely punish others. Can it be 
possible, that some peculiar structure of the cuticle, or rete mucosum, 
constitutes this idiosyncrasy? I have sometimes thought that chil- 
dren, in the maximum of animal life, were more obnoxious to the 
poison than those of lower rank in the vital scale. I do not recollect 
of ever having seen a pale looking person poisoned, at the same time, 
however, many vigorous habits are not susceptible. 

I have just learned that Dr. Hobson of New York, some time 
since, published a small work on this subject, and that it is his opi- 
nion, that the disease is seated in the rete mucosum. With this 
view I coincide, for were the skin the seat, and the mucous surfaces 
only different, by being so alive to impressions, so quick in their or- 
ganic perceptibility, the great extent of their sympathies, &c. we 
should often have it in the form of pneumonic, gastric, or enteritic in- 
flammation. I have seen the eruption spread to the corners of the 
mouth, but no farther, not even within the verge of the epithelium. 



Art. XI. On Hydrorachitis, with Cases. By Solomon Temple, 
M. D. of Philadelphia. 

HYDRORACHITIS, though not a very common disease, is of suf- 
ficient importance to claim attention It is a dropsy within the spinal 
canal, and is usually congenital 5 commencing, in all probability, in 
the first months of uterine life. At birth it is characterized, in most 
instances, by a livid spot seated upon some portion of the spinal 
column, and most frequently in the lumbar region or on the sacrum. 
This spot very soon becomes elevated, and conveys to the touch an 
evident sense of fluctuation. The tumour either ruptures at this pe- 
riod and discharges a fluid, usually transparent and resembling serum, 
but sometimes thick, flocculent, and turbid; or it increases gradually 
and sometimes attains an enormous bulk. On some occasions the tu- 



Temple on Hydrorachitis. 101 

mour is ruptured during parturition, and cases have occurred wherein 
no tumour existed, or if it had ever formed must have ruptured a 
long time previous to birth. When the tumour has remained entire 
for some days after birth, the integuments, yielding to the pressure 
of the fluid within, often become thin, and sometimes translucent, 
exhibiting the sub-cutaneous vessels minutely and beautifully inject- 
ed. In some instances the skin retains its natural thickness, and in 
others it is rugose and thicker than usual. Most frequently there is 
a defective ossification in the vertebrae subjacent to the tumour, but 
it generally consists in the absence of one or more of the spinous pro- 
cesses, the remainder of the bones being perfect. In some rare in- 
stances, the transverse processes and bony bridges are wanting, and 
still more rarely the bodies themselves. Okes, in his account of spina 
bifida, alludes to cases wherein there was no deficiency of bone. 

These are the characters usually presented by this species of drop- 
sy. It is often connected with hydrocephalus, probably nearly always 
where it continues any length of time. Sometimes there is paralysis 
or distortion of the lower extremities, attended by constipation or di- 
arrhoea, and strangury or ischuria, or there is an involuntary discharge 
both of faeces and urine. Some patients are extremely debilitated, 
others on the contrary are healthy and vigorous, and in a few cases 
remarkably lively and active, as I have witnessed in one instance. 
Few subjects of this disease survive many months; of the two which I 
have seen, one lived eight and the other four months. Instances 
are, however, recorded of patients living several years, and even to 
adult age. 

The essential characteristic of this species of dropsy, is its connec- 
tion with the cavity of the spine 5 and where it appears as an external 
tumour, there is always a direct communication with this cavity. 
When entirely confined to the spinal cavity, I know no means of de- 
termining its presence with certainty: the occurrence of the symp- 
toms mentioned above may induce us to suspect its existence, parti- 
cularly if they are combined with hydrocephalus or club-foot. 

Although this is properly considered as a congenital disease, yet 
instances are related wherein it did not occur until a few days after 
birth. Lancisi asserts that he once saw a case, in a child with hy- 
drocephalus, in which the disease did not appear before it was five 
years old; and J. Louis Alpin, that he witnessed a case in which the 
tumour did not make its appearance until the age of twenty years, 
but these are exceptions of no practical importance; in all probability 
the last two arose from hydrocephalus or from accidental injury. 

The speculations of most authors upon hydrorachitis are based upon 



102 Temple on Hydrorachitis. 

an erroneous pathology of the disease, and their writings are only va- 
luable for the facts which they contain. It is a circumstance some- 
what singular, that a disease which must in all probability have exist- 
ed in the earliest ages, did not apparently engage much attention 
until a period comparatively very recent. Little notice appears to 
have been taken of the disease previous to the time of Tulpius, who 
gave some description of it; but neither did he, nor any author of that 
period do more than call the attention of surgeons to the subject. 

Ruysch, whose rigid analytical inquiries have enriched various de- 
partments of medical science, seems to be the first who apprehended 
the real nature of the disease. He called it a dropsy of the medulla 
spinalis, and was, I have no doubt, led to this conclusion from in- 
specting the kind of lesion which attended it, and the qualities of the 
effused fluids. He says, "If we examine this swelling judiciously, 
it will appear as clear as day that it is a dropsy of a part of the spinal 
marrow, and is almost the same disorder which, when it is seated in 
the head of an infant, is called hydrocephalus. "* The investigations 
of this distinguished anatomist were made about the close of the 
seventeenth century, and afforded a clue to the correct pathology of 
the disease, but I am not aware that it was ever fully pursued. Sub- 
sequent writers have viewed it as the consequence of a lesion of some 
part of the bony structure forming the vertebral canal, and have con- 
tributed to perpetuate the use of the term by which it has been erro- 
neously designated, and which alone is intelligible to most medical 
men at the present day. It has rarely been suggested that the defi- 
ciency of bone may have been a consequence rather than a cause of 
the disease. Dr. Underwood was aware of the importance of Ruysch's 
observations, and mentions, rather hesitatingly, the real cause. I 
shall endeavour to show that the disease is coeval with, or anterior to, 
the formation of bone in the foetus, and probably anterior to the car- 
tilaginous form which bones assume, intermediate between their gela- 
tinous condition and the deposit of bony matter. I shall, for the 
present, confine myself to that variety of the disease which manifests 
itself by a tumour at the lower portion of the vertebral column, as 
I have had no opportunity of examining others, and the dissections 
heretofore made are not sufficiently minute to warrant deductions 
from them. In these cases there was probably a displacement of the 
lower portion of the medulla from a distention of its membranes, 
which must have occurred while the parts were yet soft and yield- 
ing- In the natural state this portion projects into that part of the 

* Van Swieten's Commentaries, Vol. XII. page 249. 



Temple on Hydrorachitis. 103 

gelatinous mass which represents the sacrum, but in this disease it 
bursts through the substance in which it was enveloped, and which 
was to constitute the rudiment of the bony case designed to cover 
and protect it. As the process of ossification advances no channel or 
canal is left for its accommodation in the sacrum, which its presence 
in that portion would have secured, and it is therefore finally ex- 
cluded. One reason for supposing the disease to originate anteriorly 
to the formation of bone, is that the foramina in the sacrum are per- 
fect, in their proper places, and actually occupied by the nerves, 
although these come from the inferior portion of the hydrorachitic 
sac, which could not have happened if the lower portion of the me- 
dulla had been recently protruded through the opening in the spine. 

Even if the distention were not sufficient to rupture the envelopes 
of the spinal marrow, its chief force would be directed towards the 
posterior or least resisting part, and by its pressure as effectually 
prevent the ossific process. Extending this view to other portions of 
the spine, and comparing it with the effects of serous effusion within 
the cranium, its ready application to every variety of hydrorachitis 
is obvious* But whatever may be the period at which this deficiency 
of bone occurred, we have every reason to believe that it is subse- 
quent to, and caused by, the hydropic effusion. For in the cases re- 
corded, we have no evidence either from the symptoms, or from post 
mortem examination, that any cause for this deficiency existed pri- 
marily in the part: and, from analogy, we are warranted in conclud- 
ing, that the presence of a foreign body hinders the natural process 
of ossification as well as of other functions. The inference therefore 
is, that the original cause of the disease, whatever it may be, is lo- 
cated within the canal. 

Considering the disease as a dropsy, as a collection of fluid within 
the canal, we can readily conceive the possibility of its obstructing 
the deposition of bony matter, precisely as in hydrocephalus, the 
bones composing the cranium are scarcely ever of a natural size in 
any of their dimensions, and in some instances, where an attempt 
seems to have been made towards the formation of bone, there is a 
great deficiency of calcareous matter. The cranium in such cases is 
thin, flexible, and scarcely differing from cartilage; or it is sometimes 
interspersed with small stellated patches of bony matter. 

From reflecting on the character of this disease, I had early adopt- 
ed the opinion, that the deficiency of bone arose entirely from the 
pressure of the fluid, preventing the deposition of bony matter, and 
an instance which furnishes negative evidence of this fact, is report- 
ed by Dr. Vose of Liverpool, in a case of hydrocephalus cured by 



104 Temple on Hydrorachitis, 

puncture. In this case the cranium is represented to have been a thin 
membranous bag; but on removing the pressure occasioned by the 
fluid, a rapid secretion of bone succeeded. 

As hydrorachitis is not necessarily subsequent to, or accompanied 
by any other disease, adequate to the removal of bone by promoting 
its absorption, I conclude that there could have been no vacuity in 
the bony structure antecedent to the internal disease, and whatever 
lesion may have occurred, must have been a consequence, and not 
the cause of the disease. The absence of a portion of bone, although 
it may possibly give rise to hernia, cannot, I apprehend be the cause 
of a dropsy that originates in a structure with which it has no con- 
nexion. The arachnoid membrane which secretes and encloses the 
fluid has no connexion with the vertebrse, and in a hernia of the me- 
dulla would be more likely to be ruptured than to commence the ef- 
fusion of a serous fluid. Bertrand, in 1786, about a century after 
the more accurate observations of Ruysch, called the disease a her- 
nia of the medulla spinalis. It is difficult to ascertain precisely whe- 
ther he referred to the disease in question, or to hernia of the spinal 
marrow, which, according to Hunter, Underwood, and others, 
sometimes occurs, but which is totally different from dropsy. It is in 
every important character closely allied to hernia cerebri, and has 
the same relation to it that hydrorachitis has to hydrocephalus. It is 
probable that Bertrand never examined carefully a case of spinal 
arachnoid dropsy, or he would have discovered that it possessed none 
of the characters of hernia. 

Direct and natural as these inferences appear, they are generally 
admitted only in theory, and indeed the opinions and practice of high 
authority in Europe, have been predicated on the supposition of a 
primitive defect in the spine as a cause of this dropsy; for, within 
twenty years, the disease has been professedly viewed and treated 
by a surgeon of eminence as a hernia. This idea arose, I have no 
doubt, from the erroneous term by which it has been designated, 
without giving due attention to the nature and seat of the complaint. 

A previous deficiency of bone may be a necessary condition of her- 
nia, whether it be of the spinal marrow or of the brain; but arachnoid 
dropsy, either of the brain or of the medulla spinalis, may occur with- 
out a deficiency of bone or any external evidence of its existence. 
Fungous excrescences may arise from the meninges or substance of 
the brain, or of any other part of the central portion of the nervous 
system, resembling hernia, or an accidental protrusion of a portion 
ef the subjacent organ, but there is no evidence that these excres- 
cences ever have their origin in the serous tissue. 



Temple on Hydrorachitis. 105 

The term spina bifida, although I doubt the propriety of its appli- 
cation to any of the diseases of the spine, may possibly be appropri- 
ate in hernia, or fungous excrescences from the dura mater, or peri- 
osteum of the vertebrae, but it expresses no one circumstance or 
symptom of the disease which it is meant to designate. It applies to 
a state of things which may accompany it, or may exist without it. 
A mere accidental character of the disease, therefore, and one which 
is by no means a constant attendant, should, I think, no longer give 
a name to, and a false idea of an affection with which it may be as- 
sociated, but is not necessarily connected. A bifurcated spine is, so 
far as I can ascertain, an extremely rare attendant of spina bifida. 

A deficiency of some of the spinous processes, or their entire ab- 
scence, in one or more of the vertebras, is said to be very common in 
this disease, and on some occasions no doubt communicates the im- 
pression when superficially examined, that the spine is divided at that 
part; but whether this defect in the bony structure of the canal is a 
cause or a consequence of the dropsy, it is manifest that it merely 
furnishes an outlet to a portion of the membranes distended by the 
hydropic effusion. An ignorance of the real nature of the disease, un- 
doubtedly gave rise to the term, and its continuance can only tend 
to perpetuate the mistaken views which gave it origin. 

Although considered as a dropsy, I believe its particular location 
has not been pointed out. Its source is the spinal portion of the 
arachnoid membrane, and its seat is the cavity of which this mem- 
brane forms the lining. The older writers do not seem to have ap- 
prehended that a peculiar tissue was appropriated to the secretion of 
serum, or that a disease of this texture resulted in the effusion of a 
fluid superabundant in quantity, or vitiated in its qualities. They 
were in a great measure unacquainted with the fact, that the charac= 
ters of diseases were modified by the texture which they occupied, 
while the morbid agent remained the same. They were not ignorant 
of the existence, the usual causes, and mode of relieving or curing 
the more obvious forms of dropsy, but a knowledge of the functions 
of various structures was wanting, to enable them to arrive at a cor- 
rect pathology of the disease in any of its forms, and more especially 
in those which are limited to particular cavities of small extent. It 
is not therefore surprising that one species of arachnoid dropsy should, 
from its location, be distinguished by a term referring to lesions of 
the solid parts, occasioned by a morbid action of this membrane, 
when neither the extent nor the functions of the membrane were 
known. To Bichat we are indebted for a full demonstration of this 
membrane in particular, and for a more satisfactory elucidation of the 

No. VII.— May, 1829. 14 



106 Temple on Hydrorachitis. 

functions of membranes generally, than had hitherto appeared. The 
source of dropsy, according to this truly classical anatomist, is to be 
sought in a derangement of the functions of the serous or cellular tis- 
sues. The present theory of dropsy, as deduced from this view of 
the anatomical structure, has been amply developed by Professor 
Chapman, and may be considered as established. A detail of his in- 
quiries on the subject, and his highly important practical observations 
is given in his valuable paper on Hydrocephalus, in the Philadelphia 
Journal of the Medical and Physical Sciences, New Series, Vol. IV. 
page 298. It not being my intention to embrace a view of general 
dropsy, it is sufficient to state, that he refers it to a diseased action 
of the exhalents, without necessarily involving the absorbents* 

I have alluded to the relation which subsists between hydrorachitis 
and hydrocephalus. Authority on this subject is profuse, but as on 
every other point in relation to hydrorachitis, too much has been left 
for conjecture. 

All the cases related by Sir Astley Coopepv, in which he refers to 
coma as a consequence of pressure on the spinal tumour, evince the 
connexion which subsisted in the disease between the brain and the 
spinal marrow. Okes refers in a note to a case communicated by 
Mr. Washbourn, a surgeon at Marlborough, wherein pressure on 
the tumour distended the fontanelle, and vice versa. One of the cases 
which I had an opportunity of examining, furnished me with positive 
evidence on this point. After removing the fluid effused into the 
ventricles of the brain, one of which was enormously distended, that 
contained in the hydrorachitic sac could be readily transferred to the 
same cavities by merely elevating the inferior portion of the trunk. 

Wepfer mentions a case, which, from its location, and its conse- 
quences, would seem to be different from arachnoid dropsy of the 
spinal marrow, but since it is recorded as a case of spina bifida, and 
certainly was either immediately or remotely connected in some way 
with the head, deserves to be noticed. He says he knew a girl who 
was born with a livid spot, five inches long, and three inches broad^ 
situated on the right side of the upper lumbar vertebrae. The tumour 
was soon elevated more than the thickness of the little finger. A sur- 
geon opened it, and a limpid serum issued from the orifice; when about 
three ounces were discharged, he closed the wound which readily 
healed. The tumour afterwards arose, and the mother opened it six 
times by scratching it with her nails, and each time about three 
ounces were discharged. These wounds the surgeon had no difficulty 
in healing, although they were very unscientifically inflicted. When 
the wounds were healed, and the lacerated surface was cicatrized 



Temple on Hydrorachitis. 107 

over, and no tumefaction of the part remained, a swelling appeared 
first on the " right frontal bone," and then on the left, and finally 
extending to the parietal and other bones, developed a case of well- 
marked hydrocephalus ; and there was an enormous increase in the 
size of the head. 

Van Swieten, in the twelfth volume of his Commentaries, page 
251, remarks in reference to this case, " perhaps the lymph descends 
from the ventricles of the brain." This I consider a matter of no 
consequence, as effusion may take place in any part of the cavity 
lined by the arachnoid membrane: but in the case alluded to, there 
is no evidence that any communication existed between this cavity 
and the tumour, and although evidently connected with parts exte- 
rior to the substance of the brain, it is by no means certain that it 
was a case of arachnoid dropsy. Its position on the side of the ver- 
tebral column, its appearance and progress, connected with the tume- 
faction of the scalp, would induce the supposition that the effusion 
was from cellular membrane, and bore a stronger resemblance to local 
anasarca than to hydrorachitis. 

However this may be, it is certain that dropsy of the spine is sel- 
dom elsewhere located than on the middle line of the vertebral 
column, and with a very few doubtful exceptions at the junction of 
the last lumbar vertebra with the sacrum. A case mentioned by 
Warner, Cases in Surgery, page 125, appears to me to have been 
hydrocephalus. He says he saw a tumour on the occiput precisely 
resembling those which occur on the spine. Although in this case, 
the occipital bone was almost wholly defective, yet the child was 
lusty and strong, and there was no visible disease of the limbs. He 
advised nothing but palliatives; the tumour was, however, opened 
by another surgeon, and the child died in a few days. 

It is important to distinguish with greater accuracy than has 
hitherto been done between hydrorachitis and diseases which bear a 
general resemblance to it. My acquaintance with parenchymatous 
tumours on the spine, as they are called by Underwood, with herniae 
or fungi of the medulla spinalis, is too limited to enable me to de- 
scribe with precision the best modes of distinguishing them from the 
tumour in hydrorachitis; but in the latter disease there is an effusion 
more or less resembling serum within the spinal cavity, and most 
probably within the cavity lined by the arachnoid membrane; the 
tumour, which is generally present, is soft, fluctuating, and elastic; it 
is mostly diaphanous, and always has a direct communication with the 
vertebral canal. In the tumours which resemble it, none of these 
characters usually obtain; their connexion with the interior of the 



108 Temple on Hydrorachitis, 

canal is doubtful, they are never elastic, and excepting in cases of 
hernia, always arise exteriorly to the dura mater, or from this mem- 
brane. 

When the tumour is seated at the base of the sacrum, which ap- 
pears to be its proper location, as it is rarely found in any other 
position, there is a diagnostic mark which I consider more important 
than any above mentioned, and which, so far as I could discover, has 
never been before noticed. It is a spot at the most projecting part 
of the tumour, of a firmer consistence than any other portion of its 
parietes, and which, from its appearance, and the circumstance of a 
small quantity of fluid issuing from it soon after the birth of the 
child, I had regarded until lately as the cicatrix following a sponta- 
neous or accidental rupture at the part. But it marks the termina- 
tion of the spinal marrow, which is proportionately longer in infancy, 
and owing to its displacement at an early period, as was before ob- 
served, extends with the branches composing the cauda equina, to the 
apex of the sac, where their filaments are apparently lost in the firm 
flesh-like substance alluded to. The sacral nerves spring from this 
substance as from a second point of origin, and in the dissections 
hereafter detailed, I was not able to trace their connexion with the 
descending filaments from the spinal marrow. Neither the spinal 
marrow nor its immediate branches appear to have any determinate 
connexion with the sides of the tumour, until they reach the apex, 
although I have met with adventitious adhesions slightly uniting 
them to each other or to the walls of the sac, which were probably 
the result of inflammation in the arachnoid membrane. The import- 
ance of this view of the anatomical arrangement of parts will be re- 
ferred to when noticing the modes proposed for alleviating or curing 
the disease. 

I shall now give a short detail of the two cases, which fell under 
my observation, and first drew my attention to the disease. 

Case I.— W. G. born May 22d, 1826. The mother stated, that 
at the birth of the child, a livid spot was observed on the lower part 
of the back, and the midwife informed her that " a joint was missing." 
The spot became tumid in a few days, and a watery fluid was per- 
ceived to exude from the upper part of the tumour, by a perpendi- 
cular fissure which soon closed. When I first saw him he was more 
than two months old; a large boy, and his general aspect very 
healthy. My note made at the time states, that a tumour presented 
apparently at the base of the sacrum, or possibly over the upper part 
of it, of a cordate form; and about two inches and a quarter in length, 



Temple on Hydrorachitis* 100 

by two inches broad, and elevated in the middle more than half an 
inch. Its general colour was reddish, in consequence of being tra- 
versed in every direction with red streaks, the ramification and anas- 
tomosis of minute vessels, somewhat resembling a thin bladder dis= 
tended with blood and water, imperfectly intermingled. There was 
a cicatrix precisely in the middle where it had been open, and which 
seemed to give it the heart shape which it presented. On pressing 
with the finger on the place of the spine, at the edge of the tumour, 
I could not perceive any deficiency in the vertebrae. As I did not 
know at that time the residence of the child, it was nearly two 
months before I saw him again. At this time the tumour was very 
large; its horizontal diameter at the base about three inches and a 
half, the perpendicular nearly three inches, and the elevation above 
the surrounding integuments about two inches. Its appearance is 
nearly as before, but I think not quite so diaphanous. It is obviously 
increasing in size, as a part of the sound integuments are elevated, 
and constitute a portion of the base of the tumour, which the mother 
says has always preceded its sensible enlargement. They are first 
elevated, then appear inflamed, and afterwards assume the diapha- 
nous appearance of the other part of the tumour. The pulsation of 
the aorta is distinctly felt at the upper edge of the tumour. There 
is no paralysis, nor any symptoms of hydrocephalus, the excretions 
are natural and voluntary, and the child is robust and active, and, in 
short, there is full evidence of perfect health, and of a healthy con- 
formation, excepting in this particular. He is now about four months 
old. In this situation he continued many weeks, without any other 
change than a gradual increase in the size of the tumour, and the 
consequent progress of the disease. I saw him occasionally, but was 
called, January 26, 1827, and found that the tumour had com- 
menced ulcerating about the 14th, attended by a very slight fever, 
not sufficient to create any alarm. The tumour is about fourteen 
inches in circumference, the integuments surrounding it are red, as 
from inflammation, forming a ring about ten lines in breadth, nearly 
all around the tumour, with a margin pretty well defined. This red 
ness disappeared next morning, but occurred occasionally for two or 
three days. The ulceration appeared to commence and extend to the 
greatest depth, where the old cicatrix remained in the centre, proba- 
bly in consequence of a thickening of the integuments in this part 
from previous ulceration; as the walls of the sac are thicker here than 
elsewhere, and appear less vascular. The ulceration of the integu- 
ments daily progresses, but not very rapidly, his strength has dimi- 
nished, he is pale, but has not lost much flesh; he takes his food with 



110 Temple on Hydrorachitis. 

some avidity, but occasionally deglutition has been « rather difficult 
for a few days, and he cannot readily take the breast. 

February 2d — A small quantity of fluid has, at various times 
within the last week, issued from different parts of the ulcerated sur- 
face; but to-day, the tumour ruptured, and after two or three ounces 
had been discharged, I reapplied the dressings, to prevent a further 
flow at that time. The dressing was a simple cerate, and employed 
chiefly to protect the tumour. The ulceration has extended nearly 
over the whole surface: it completely occupies the central parts, and 
has considerable depth at the upper part. The discharge has conti- 
nued gently through the day and evening. Pulse about 180 in the 
minute. 

February 3d. — To-day the sac suddenly discharged most of its 
contents: I saw him soon: the depression was considerable, but not 
so great as I had expected. The pulse was weak, and about 200. 
The collapse of the tumour showed a deficiency in the spine, the va- 
cuity large enough to contain a pullet's egg. At this time there are 
symptoms of cerebral effusion. A small quantity of fluid issued from 
his eyes. The pulse is very weak, and upwards of 200. 

February 4th. — The sac is again filling, and when distended, the 
skin is warmer, and the pulse more frequent. The stools are green- 
ish, and their passage has given him pain, for several days past. The 
urine is passed involuntarily. His eyes do not appear to be entirely 
insensible to the action of light, but its impression is doubtful. I no- 
ticed that his pulse was subject to sudden alterations, which appeared 
to have some relation to the quantity of fluid in the sac; the discharge 
of which, on account of the extensive ulceration, could not be con- 
trolled. On one occasion, when his pulse was certainly much above 
200, I drew off, from estimation, one ounce of the fluid, and imme- 
diately found his pulse 180, and fuller than before. It soon after- 
wards rose. 

Irregularity in the discharge of faeces and urine, as well as in the 
circulation, continued. The temperature, both of the superior and 
the inferior extremities, varies, and they exhibit a little convulsive 
agitation. This agitation continued, and increased until death, which 
occurred this evening. A few hours before death his breathing be- 
came very laborious, and he was unable to swallow. Considerable 
quantities of flocculi, resembling coagulated lymph, were mingled 
with the fluid discharged yesterday and to-day. 

A post mortem examination was made, February 5, in which I 
was assisted by Dr. J. R. Barton and Dr. J. W. Ash, and the pre- 
paration procured, from which the annexed drawing was made. See 



Temple on Hydrorachitis. Ill 

plate I. Dissection presented the following appearances. On ex- 
posing the cavity of the sac, it was found to be, in part, occupied by 
the lower portion of the spinal marrow, and the cauda equina, which 
entered it by an opening beneath the last lumbar vertebra, occa- 
sioned by a deficiency in the posterior part of the sacrum, in which 
the spinous processes were wanting. On each side of the middle line 
of the sacrum, on its posterior face, was a ridge of bone, the com- 
mencement, or abutments, of the bony arch, which, in the healthy 
condition, encloses the sacral nerves and the prolongation of the me- 
dulla spinalis. The lower anterior portion of the sac lay in contact 
with these ridges and the space between them. The opening by 
which the sac and its contents communicated with the spinal cavity, 
would barely admit the point of the little finger. The lumbar ver- 
tebrae were natural. The sac consisted of the distended dura mater, 
covering the spinal marrow, lined by arachnoid membrane, which was 
reflected over its internal face, and also covered the medulla spinalis 
and the nerves. The medulla spinalis and the nervous cords descend- 
ing with it, passed freely through the neck of the sac, and, after 
forming a membranous expansion, became united to the dura mater 
at the apex of the sac. Their insertion occupied a space of about 
half an inch in diameter, in a thick, firm substance, of an inch in dia- 
meter. The nervous filaments could not be traced through this sub- 
stance, but surrounding the insertion of the descending branches, and 
entirely distinct from them, certain nervous filaments arose, first in 
minute shreds connected by a delicate membrane, then coalescing 
into slender cords, formed, as they emerged from the cavity of the 
sac, two cords only, one of which had a ganglion 5 and here the two 
nerves united into a single trunk. These ganglia in the sacrum were 
situated in the foramina of the os sacrum; those of the twenty-third 
and twenty-fourth pairs of nerves, after their component cords had 
passed through the inter-vertebral foramina. I supposed the gan- 
glionic nerves were similar to those arising from the posterior co- 
lumns of the spinal marrow, and therefore called the two anterior and 
posterior fasciculi, although I could not, excepting in the case of the 
twenty-third pair, trace their connexion with the descending branches. 
The anterior and posterior fasciculi had distinct origins in the firm 
substance above alluded to, and in a few of them separated to a con- 
siderable distance. The nerves above the twenty-third, arose in the 
usual way, but the posterior branch of this nerve arose from the firm 
substance at the centre of the sac, while the anterior, descending 
nearly to the central point, and detaching a slender filament to it, re- 
turned at an acute angle to its proper foramen. This occurred only 



112 Temple on HydrorachUis. 

on the right side. All the parts presented marks of inflammation, but 
the inner face of the sac the least. 

The firm substance at the apex of the tumour, was situated pre- 
cisely beneath the perpendicular fissure previously mentioned, and I 
found that it constituted what I had supposed was the cicatrix, fol- 
lowing the slight rupture of the integuments. The skin upon it is 
changed, and has become identified with the parts beneath; this, to- 
gether with its hardness, rendered it easily perceptible during the life 
of the patient. 

The sacral nerves in passing to their proper foramina, occupy 
chiefly the lateral portions of the cavity; a few of them lay near the 
sides, but most of them proceeded directly through the cavity. I re- 
gret that in this case the brain was not examined. 

Case II. — A coloured child, about four weeks old, had a tumour 
on the base of the sacrum, its general appearance very similar to that 
above described, but it was more elevated, and the integuments were 
thicker. There was a circular spot on the apex of the tumour, three 
or four lines in diameter, much thicker and harder than the other 
parts. It was considered the cicatrix following a slight rupture, which 
the mother stated had taken place three or four days after the birth 
of the child, and from which she had observed a small quantity of 
fluid to issue several times. His form was remarkably handsome, 
particularly his head, which had not the shape peculiar to his colour. 
There was no symptom of hydrocephalus, nor any paralysis of any 
portion of the body. 

In about a month I noticed considerable difficulty of breathing; it 
resembled snoring, and became so loud, at last, as to be readily 
heard in an adjoining room. General health apparently good; no pa- 
ralysis; excretions free and natural; thought by the mother to be 
greater in quantity than natural. 

A few days afterwards I noticed that the integuments over the an- 
terior fontanelle and upper part of the os frontis, were slightly tume- 
fied, as from the pressure of a fluid within. After this time the symp- 
toms of hydrocephalus became daily more obvious, but the size of the 
spinal tumour increased very slowly, which was precisely the reverse 
of what happened in the case of W. G. During the last month of his 
life he had paralysis, with some distortion of the lower extremities, 
irregularity in the actions of the bladder and rectum, attended 
with repeated convulsions. He was four months old when he died. 

A post mortem examination was made in which Dr. A. Comstock 
assisted me. As the appearances on dissection in this case were very 






Temple on Hydrorachitis. 113 

similar to the last, I shall only note the variations. The tumour was 
not more than one-fourth the size, yet the os sacrum was less perfect 
at its upper posterior part, and consequently the opening into the spi- 
nal cavity was larger: it would readily admit the point of the little 
finger. The spinal marrow and the cauda equina, terminated as in 
the former case, in a thick firm substance, but smaller. The sacral 
nerves arose in a similar manner; but in passing to their proper fora- 
mina, lay nearly in contact with the internal part of the parietes of 
the sac: they were invested, however, with arachnoid membrane, 
which was also reflected over the dura mater lining the sac. 

A direct communication existed between the cavity of the sac and 
the ventricles of the brain, through the tube formed by the dura ma- 
ter, and by way of the fourth ventricle, which was large enough to 
admit the finger. The ventricles contained nearly six ounces of a 
limpid fluid, of which three-fourths were found in the lateral ventri- 
cle of the left side, which was at least three times larger than that of 
the right. The fluid in the sac was similar to that found in the ven- 
tricles. The substance of the brain was not apparently altered. The 
disease appears to have affected the left side more than the right. 
The left testicle had not descended to the scrotum: it was found 
lying on the psoas magnus muscle, near its entrance into the pelvis. 

That the external mark, indicating the relative position of impor- 
tant parts within, is not an uncommon occurrence, I think may be 
plainly inferred from many cases: I shall refer to two or three only. 

Sir Astley Cooper's case of Mrs. Little's child, is one from which 
I should draw the inference. After a cure had been effected, he says, 
" the skin now hangs flaccid from the basis of the sacrum; its centre is 
drawn to the spine, to which it is united, and thus the appearance of 
a navel is produced in the tumour by retraction of the skin." Also 
the case of Hannah Jackman, reported by him, and one communicat- 
ed to me by my friend, Dr. Henry Lee Heiskell of Virginia, were 
in my opinion, examples of the existence of this external mark. The 
latter I cannot describe better than in the words of his note. 

" The case was that of a coloured child, four weeks old at the time 
I saw it, as large as children commonly are at that age. The tumour 
was between the last lumbar vertebrae and the sacrum, as large as a 
turkey's egg, perfectly diaphanous, and filled with a transparent 
fluid; its apex had taken on incipient ulceration. The space between 
the bones would admit the ends of the fingers. There was considera- 
ble distortion of the lower extremities, the legs and thighs being per- 
manently fixed at right angles with the body; in addition to this, there 

No. VII.— May, 1829. 15 



1 14 Temple on Hydrorachitis. 

was distortion of the feet inwards." Dr. Heiskell had no opportu- 
nity of examining after death. The tumour remained entire. 

The modes proposed for alleviating or curing the disease, are mo- 
derate and well regulated pressure, puncturing the tumour with fine 
instruments, the application of a ligature around the base of the tu- 
mour, and the excision of the tumour. The last need not detain us 
longer than to reprobate it. It never can be proper in hydrorachitis, 
however it may succeed in tumours which resemble it. 

It is said that the application of a ligature has succeeded in the 
hands of a surgeon in Connecticut, but on inquiry I find the child 
continues paralytic as before. It is not, therefore, to be considered a 
cure, unless the child has since improved. The tumour sloughed 
away in due time, but it contained "something more than the inte- 
guments." On considering the nature of the lesion, it must appear 
evident that the application of a ligature would be highly injudicious 
in all cases similar to those which I have detailed. In the first case, 
all the nerves from the twenty-third to the thirtieth inclusive, would 
have been embraced by a ligature, and the consequences of its em- 
ployment are readily inferred. 

The only means, therefore, which can be safely resorted to, are 
pressure upon the tumour, and puncturing it with fine instruments. 

The proper time for employing pressure, is at the moment the dis- 
ease is discovered, and it should never be neglected by the accou- 
cheur or midwife in attendance. It is then, in most cases, as above 
stated, merely a livid spot, and while in this condition, compression 
would afford a better prospect of success than at any subsequent pe- 
riod. 

If this precaution has been neglected, gentle, steady and gradually 
augmented pressure, may still be employed, if the tumour be not 
large. It should not, however, be made with a block of plaster of 
Paris, as was ineffectually tried by Sir Astley Cooper, upon what 
principle I know not. Many better modes will suggest themselves 
to the surgeon; and that afterwards employed by himself is far pre- 
ferable. That which I should adopt where the integuments are not 
yet elevated, would be, first to cover the part with a piece of oiled 
silk, and pass over this a broad muslin bandage, to encircle the body. 
I would then apply, as recommended by Cooper, a properly adjusted 
truss, similar to those used for umbilical hernia, with a regulated 
compress beneath the pad, which I think ought to be flat. 

If there be a small tumour, I should cover it with the oiled cloth, 
and apply a bandage, without employing the truss, until I had suc- 
ceeded in reducing its size, if this could be safely effected. 



Temple on Hydrorachitis. 115 

If the tumour be large, it is not probable that pressure alone will 
succeed; and it may indeed be productive of alarming, or even fatal 
consequences. 

Under such circumstances, I think it would be justifiable to dis- 
charge the contents of the sac gradually, although you necessarily 
puncture the dura mater. Two cases are said to have been cured by 
this means, aided by pressure, by Dr. Bozzetti of Padua;* and al- 
though it has failed in the cases in which it was employed by Mr. 
Abernethy and Sir Astley Cooper, it was not productive of any 
immediate ill effects. Nearly forty years ago, the same measure was 
resorted to by Dr. Physick, for the cure of hydrocephalus, and sub- 
sequently by Dr. Glover of Charleston, Dr. Vose of Liverpool, and 
others; and if the results are not such as to make us very sanguine of 
success, at least they seem to show the propriety, when other means 
fail, (as the disease is necessarily fatal when left to nature,) of resort- 
ing to this. It is not to be expected, however, that operations of this 
kind shall prove equally successful with those employed in ascites, 
&c. The fibrous dura mater does not readily heal. The proper place, 
and the proper mode of performing the operation, are therefore mat- 
ters of some consequence. If the view which I have given of the ana- 
tomical arrangement of parts has any value, it is in directing this ope- 
ration. 

As the nerves occupy the apex and the lateral portions of the sac, 
it is obvious that punctures should be made at the base of the tumour, 
either above or below, and near the middle line of the body. If the 
hardened spot, or cicatrix, to which I have alluded, should be situated 
low down upon the tumour, the puncture should be made above, but 
generally it would be better to make it below, as there would then 
be less risk of wounding the descending spinal marrow and nerves. 

I would propose to make the puncture in the sound integuments 
with a fine instrument, properly curved, to avoid wounding important 
parts within the sac, inserting it three or four lines from the edge of 
the tumour, and elevating the point into its cavity. By this means 
the discharge of the fluid could be controlled, and the orifice readily 
closed. The operation should not be performed when the parts are 
inflamed, nor should the sac be emptied at once. The part should be 
supported, and even compression may be made to advantage, during 
the intervals. It may be proper also to try the effect of such internal 
remedies as are employed in hydrocephalus. I am aware that success 
has rarely followed any mode of treatment, but I think that an at- 
tempt to relieve or cure can generally be made with safety. 

* See Vol. II. page 221, of this Journal 



116 Temple on Hydrorachitis. 

Explanation of the Plate. 

The drawing represents the sac opened by a perpendicular slit, a 
little to the left of the middle line of the body Its cavity is seen at 
a, a. 

1. Ends of the bony arches of the last four lumbar vertebrae cut off. 

2. The 21st, 22d, and 23d spinal nerves of the right side, cut off 

after they have penetrated the dura mater. 

3. The dura mater at the part to which it was slit open to expose the 

spinal marrow and nerves. 

4. The spinal marrow and cauda equina proceeding towards the apex 

of the tumour, expanding and attaching themselves to the walls 
of the sac. 

5. The apex of the tumour, a thick firm substance, in which the spi- 

nal marrow, &c. terminate. Separated portions of it on each 
side, and from which many of the nerves arise, are represented 
at 6. 6. 6. 

7. 7. 7. Perforations and ragged edges caused by ulceration. 

8. The ascending filaments of the 23d nerve of the left side, both an- 

terior and posterior, arising from the membranous expansion. 
The 23d nerve of the right side is concealed by the spinal mar- 
row. 

9. 9. Branches of the 24th nerve, and of the sacral nerves. 

10. A part of the common skin, fat, muscles, &c. of the back. 



JPcuje 116 



Plate 1. Vol. 4, 




■ZDrayton Sc, 



( m ) 



MEDICAL EDUCATION AND INSTITUTIONS. 

Art. XII. Account of the Hopital de la Pitie, Hopital de St, An- 
toine, Hopital Necker, Hopital Cochin, and Hopital Beaujon at 
Paris. By Elisha Bartlett, M. D. of Lowell, Mass. 

IN following the course which we have adopted, in treating of the 
medical institutions of Paris, in point of interest and importance to 
the American student, and perhaps generally, comes the Hopital de 
la Pitie. This establishment within a few years has taken a high 
rank among its kindred institutions, in consequence of the exertions 
and achievements of its chief surgeon, Lisfranc. 

The disorders and civil wars during the regency of Maria de Me- 
decis, had increased so considerably the number of the poor, that the 
singular remedy was resorted to of imprisoning them. In consequence 
of this regulation, in 1612 the buildings at present occupied by La 
Pitie were appropriated by the magistrates for this prison, in which 
were shut up those of the poor who were arrested. In 1657, when 
Saltpetriere was built, the houses of La Pitie were destined to another 
use. The children of the mendicants were placed there, and the two 
sexes each received an education proper for preparing them to live 
honestly and usefully. To these were added illegitimate children 
and orphans, who received a similar education. In 1809 the orphans 
were sent to the "Hospice du Faubourg St. Antoine," and La Pitie 
became an annex of the Hotel Dieu, and was appropriated to the same 
diseases as that hospital. La Pitie now contains six hundred beds, 
distributed in twenty -three wards. 

The visits at this hospital are made at the same hours as at the 
Hotel Dieu and La Charite. After the morning visit, during part of 
the year, there are clinical lectures on surgery by Lisfranc, which 
are attended by a large number of students. 

Whole number of beds, 600. 

Medicine. Surgery. 

Men 293 - - • - 64 

Women 207 - - - - 36 



118 Bartlett's Account of the Hospitals of Paris. 



Statistical Table from i 


he Annual Report of 1822 










MEN. 


WOMEN. 


2 

U 

p 


13 
h 




Med. 


Surg. 


Total. 


Med. 


Surg. 


Total. 


In the hospital, Jan. 




















1, 1822 - - 


143 


34 


177 


165 


35 


200 


377 


513 


70 


Admitted during the 




















year - 


2242 


582 


2824 


1520 


421 


1941 


4765 


2993 




Dismissed 


1938 


535 


2473 


1268 


390 


1658 


4131 


2651 


70 


Deaths - 


307 


28 


335 


273 


25 


298 


633 


408 




Remaining 31st Dec. 




















1822 - - - 


140 


53 


193 


144 


41 


185 


378 


447 




Rate of mortality, one 




















for - 


7.77 


22.0 




6.17 


18.24 










Mean number of days 




















in the hospital - 


20 


30 




36 


35 











The number of individuals affected with small-pox was one hun- 
dred and eighty four, of whom forty-eight died, and one hundred and 
thirty-six were cured, or in the hospital at the end of the year. In 
1821, there were only nineteen cases, of which but two were fatal. The 
ages which gave the most diseases were from eighteen to thirty. The 
cures were gastric and putrid fevers, pulmonary catarrhs, paralysis, 
small-pox, fractures, contusions, abscesses, and ophthalmias. The 
deaths were from bilious fevers, enteritis, pneumonias, apoplexies, 
tubercular phthisis, small-pox, and diseases of the heart. 



Surgery of La Pitii for the year 1822. 

1 Ligatures of veins of the legs 
8 Fracture of clavicle 

of humerus, (neck) 

of humerus, (body) 

of bones of fore-arm 



- of ribs 

- of thigh, (neck of bone) 

- of thigh, (body of bone) 
-- of leg ... 

- of leg, (compound) - 
of patella 



Trepan 

Cataracts .... 

Empyema .... 1 

Paracentesis abdominis 80 

Hydrocele - 8 

Lithotomy - - - 1 

Fistula in ano - 6 

Extirpation of cancerous tumours 12 

Amputation of thigh - - 3 

of leg - 5 

of toes - 6 

of thumb - - 1 

Resection of bones of metatarsus 2 

It has already been observed that this hospital has, within a few 
years, become one of much interest to the medical inquirer, on ac- 
count of the lectures and practice of M. Lisfranc. This gentleman 
may certainly be ranked among the most distinguished surgeons of 
Paris. The success of his amputations of the neck of the uterus in 
cases of disease of that organ, is well known in this country. In his 
practice he is one of the most thorough-going of the Broussaisists. I 



Luxation of humerus 



15 

8 
3 
9 
6 
8 
12 
6 
4 
6 
2 
4 



Bartlett's Account of the Hospitals of Paris. 119 

have known him in a fracture of the spine, of two months standing, with 
paralysis of the lower extremities, bladder, and rectum, commence the 
treatment by bleeding on the first day twelve ounces, second day ten, 
third day eight, thus gradually diminishing the daily bleedings down 
to two ounces. During this time an immense number of leeches were 
applied along the spine; say two or three hundred in the course of 
seven or eight days. After an interval of three or four days, he re- 
commenced the bleedings, gradually diminishing them as before. At 
the expiration of this time, "C'est bien remarkable!" exclaimed the 
surgeon, as the patient began to use his legs, and the rectum and blad- 
der were resuming their functions. Nothing is more common than 
to hear him prescribe seventy or eighty leeches daily, for a scrofulous 
inflammation of a joint. 

There are greater facilities for the study of anatomy and surgery 
connected with this hospital than with any other in Paris. The two 
principal places for dissection are at the Pavilions connected with the 
school of medicine at the Ecole Pratique, and at La Pitie. Perhaps 
there is little choice between the two, though there are some advan- 
tages at La Pitie, for an American student who spends but a limited 
time in Paris. The distribution of subjects is made every day at noon 
in the following order. The in-dressers of the hospitals have the pri- 
vilege of the first choice, the out-dressers the second, and the re- 
maining subjects are distributed among the miscellaneous students, 
in the order in which their names are inscribed on the distribution 
book. The price is fixed by the administration of the hospitals, and 
is moderate. 

In addition to the public establishments just spoken of, there are 
several private teachers of anatomy, with whom a considerable num- 
ber of American and English students in Paris pursue their dissec- 
tions. These gentlemen take upon themselves the trouble of pro- 
viding subjects, preparing them, and furnishing rooms, tables, &c. It 
is somewhat more expensive to dissect under the direction of one of 
these private teachers; but the advantages particularly to a student 
who has but little time in Paris, are more than sufficient to overba- 
lance the additional cost. One is thus rid of the trouble of procur- 
ing subjects, and removed from the noise and confusion of the public 
rooms. The writer dissected with Mr. Fisher, an Englishman, who 
has a room at La Pitie, and a class composed principally of American 
and English students. M. Amusat has also a similar establishment 
where dissections can be pursued a great part of the year. His 
terms are considerably higher. 

Among other advantages connected with La Pitie, are Lisfranc's 



120 Bartlctt's Account of the Hospitals of Paris. 

lectures on operative surgery. The professor first gives a lecture on 
the operation, then performs it on the subject, and during the course, 
which continues about three months, each of the students does all 
the operations twice, which can be performed on the dead subject, 
under the direction of Lisfranc or some one of his assistants. 

Lisfranc, as a lecturer and a man, has less of the French polish 
than any other public character whom an American student meets 
in the course of his studies at Paris. He has a goodly share of im- 
pudence, bravado and vulgarity, but in connexion with these una- 
miable qualities, there is a redeeming fund of wit and good humour, 
a high and aspiring ambition, an ardent devotion to the science and 
the art, which he has so much embellished and improved, and a mi- 
nute and accurate knowledge of anatomy, rendering him a proud and 
successful rival of the first operators of the French metropolis. In 
the edition of Sabatier's Medecine Operatoire, published by Sanson 
and Begin, many of Lisfranc's methods of operating are detailed 5 
but in noticing these in his lectures, he usually gets in a passion, 
says the accounts are travestied, calls Breschet a gross beast, a bro- 
ken pot, &c. He treats with ridicule the vague and indefinite direc- 
tions generally given in books of operative surgery, and insists with 
much emphasis on the necessity of reducing these rules as far as pos- 
sible, to mathematical precision. He says operators consist of three 
classes — first, the man of the world; second, the amateur; and third, 
the artist. He mimics, in a very amusing manner, the style of ope- 
rating by the two first, and then shows how the artist would use the 
instrument, and consequently how an operation should always be 
performed. All the time of my attendance at La Pitie, Lisfranc was 
promising from month to month a system of operative surgery, which 
was then stated to be in press. 

Of the seven hospitals of Paris devoted to the ordinary diseases of 
adults, we have already noticed the three most important, viz. the 
Hotel Dieu, La Charite, and La Pitie. We shall here briefly speak 
of the remaining four, leaving the consideration of those hospitals, 
destined for the reception and treatment of particular classes of dis- 
ease, to a future number. These four are St. Antoine, Necker, Co- 
chin, and Beaujon. 

Hopital de St. Antoine. — The Abbey of St. Antoine was suppress- 
ed in 1790, and by a decree of the Convention in 1795, converted 
into a hospital, which at first contained one hundred and sixty beds. 
There are now between two and three hundred. This, though a small 
establishment, is distinguished among the other hospitals, by the 



Bartlett's Account of the Hospitals of Paris. 121 



beauty of its exterior, its internal commodiousness and neatness, and 
the care and attention bestowed on the patients here received and 
treated. 

Whole number of beds, 262. 

Medicine. Surgery. 

Men 108 - - - 32 

Women --„.„„ 98 - - - 24 



Statistical Table from 


the Annual Report c/1822. 








MEN. 


WOMEN. 




1? 

Soo 


2 . 














H 


60~ 

f 


Med. 


Surg. 


Total. 


Med. 


Surg. 


Total. 


In the hospital, 


















Jan. 1, 1822 


97 


32 


129 


67 


18 


85 


214 


257 


Admitted dur- 


















ing the year 


1,277 


404 


1,681 


876 


195 


1,071 


2,752 


2,487 


Dismissed 


1,084 


371 


1,455 


684 


176 


860 


2,315 


2,124 


Deaths - 


184 


34 


218 


170 


18 


188 


406 


408 


Remaining 31st 


















Dec. 1822 - 


106 


31 


137 


87 


19 


106 


243 


212 


Rate of mortali- 


















ty, one for 


6.89 


11.91 




5.02 


10.78 








Mean number of 


















days in the 


















hospital 


29 


29 




35 


35 









Surgery of St- JLntoinefor the year 1822, 



Incisions for anthrax 5 

for whitlow 30 

Lithotomy - 1 

Amputation of thigh 1 

ofleg 3 

— - — — — of great toe 1 

Resection of tibia - 1 

Extirpation of scirrhous tumour 1 



Strangulated hernia * - 2 

Incisions for abscess - - 35 

Polypus of nose - 2 

Hydrocele - 2 
Extirpation of sarcomatous tumours 2 

Fractures ... 70 

Ligatures of arteries 10 



Hopitals Necker, Cochin, and Beaujon. 

These hospitals are not of sufficient extent or importance to justify 
giving a separate notice, with a table of population, mortality, &c. 
for each of them. 

The Hopital Necker was founded by Madame Necker, in the con- 
vent of the Benedictines. The number of beds in 1822 was 120. 
There were then nearly two thousand patients received annually. 

The Hopital Cochin was founded in 1782 by M. Cochin, curate of 
St. Jacques. It contains 125 beds, is clean and well ventilated, and 
its inmates are attended with particular care by the sisters of St. 
Martha, distinguished by their active and careful attention. 

No. VII.— May, 1829. 16 



122 Bartlett's Account of the Hospitals of Paris. 

The Hopital Beaujon was founded in 1784 by M. Beaujon, a rich 
financier, and intended for the reception of twenty-four orphans, 
twelve of each sex. In 1795 a decree of the convention changed the 
establishment into a hospital for the sick and wounded. The benevo- 
lent founder expended on the hospital nearly three hundred thousand 
dollars, besides making an annual donation of between three and four 
thousand dollars. Excepting the hospital of St. Antoine, this is the 
most beautiful in Paris. There are no large wards, the interior being 
divided into rooms containing six or eight beds. It is served by the 
sisters of St. Martha, and is deservedly celebrated for its cleanliness 
and salubrity. From 1804 to 1814 there were received at St. An- 
toine 13, 787, patients. In 1822 there were twenty-eight patients with 
small-pox, ten of whom died. There were received into the three 
above-named hospitals in 1822, 4313 patients. We shall give in one 
table the 

Surgery of the Hospitals Necker, Cochin, and Beaujon, for the year 1822. 






Amputation of thigh - " - 5 

' ■ of leg - 5 

of fingers 8 

■ of toes - 2 

of forearm 1 

■ of hand 1 



Fractures 18 

Extraction of cancerous tumours 9 
of polypus of nose - 2 



Incisions for whitlow 9 
— — — for phlegmon 3 
for abscess 15 



Lowell, Massachusetts, March 10 ? 1829, 



( 123 ) 



REVIEWS. 

Art. XIII. Pathological and Practical Researches on Diseases of the 
Stomach, the Intestinal Canal, the Liver, and other Viscera of the 
Abdomen. By John Abercrombie, M. D. Fellow of the Royal 
College of Physicians of Edinburgh, &c. and First Physician to 
his Majesty in Scotland. Edinburgh, 1828. pp. 396, 8vo. 

JMORBID affections of the digestive organs stand in the avenue 
by which the physician enters the field of practice, exacting from him 
the most scrupulous attention and continued observation. In addi- 
tion to their multitude, and the variety of forms in which they appear 
as idiopathic or independent diseases, they are ever ready to fall into 
the train of other maladies, sometimes exasperating these to greater 
violence, and at others usurping their places and taking on charac- 
ters more formidable than those of the original affections. It is there- 
fore nowise surprising that they should have formed frequent subjects 
of inquiry, and received an ample proportion of speculation. Nor can 
it be denied that much useful practical information has resulted from 
previous observation and experience, but it is very certain that the 
pathology of diseases of the abdominal viscera has hitherto been ex- 
ceedingly obscure, and so erroneous withal, as to lead often to the 
most dangerous modes of treatment. No better proof we think need 
be given of the confused opinions which hav« prevailed upon these 
topics, than a reference to the various modes of practice pursued by 
physicians of the greatest celebrity. 

Within the last twenty years a precision has been attained in the 
diagnosis of diseases, which has greatly advanced the progress of the 
healing art, and for this incalculable advantage we certainly stand 
indebted mainly to the researches of the French. Dr. Abercrombie 
would fain have us believe that he is no advocate for the doctrines of 
the French pathologists, yet it is evident even from the first para- 
graph of his book, that he has attempted to build upon a foundation laid 
by them. He pays the strictest attention to the distinctions established 
by these in relation to the primary textures of organs, and the various 
and peculiar morbid derangements to which these tissues are liable. 
Had Dr. Abercombie conformed still more closely to the tenets of 
his continental brethren, especially in regard to some practical points, 



124 Abercrombie on Diseases of the Stomach, fyc. 

we think his book would have possessed still greater value. As it is, 
however, we look upon it as composed under more favourable auspices 
than any other upon the same subject, in the English language at 
least, and propose giving a view of the most important matters of 
which it treats. This summary will be found rather analytic than 
critical, the chief object being to present our readers with practical 
information. 

The author sets out with a physiological and pathological view of 
the various structures composing those organs, the diseases of which 
he proposes to investigate, and as we think his introductory obser- 
vations may be interesting to many of our readers, we shall make free 
extracts from them. 

The peritoneal, the muscular, and the mucous coats of the intes- 
tinal canal are the three structures concerned in this treatise. 

The peritoneum, as is well known, is a serous membrane, liable to 
both acute and chronic inflammation, and to various remarkable 
changes of structure, some of which are evidently the result of in- 
flammatory action, whilst others seem to have a different origin. The 
first effect of a certain low degree of inflammatory action upon serous 
membranes, appears to be simply an increased deposition of the serous 
fluid; and in this manner it is probable that a state of these mem- 
branes, which if not actually inflammatory, closely borders upon it, 
is sometimes relieved; the increased quantity of fluid being after- 
wards absorbed, and the parts thus recovering their healthy relations. 

Remarkable varieties in the characters of the fluid deposited are, 
however, observed in different morbid conditions, some of which will 
afterwards be described. 

Besides the diversities exhibited in their effused fluids, serous mem- 
branes, are chiefly liable to three morbid conditions of structure, 
viz. simple thickening, tubercular disease, and another affection 
wherein the surface of the membrane appears covered with nodules 
of various shapes and sizes, of a semi-pellucid character and smooth 
rounded surface. 

The second structure is the muscular coat, which completely in- 
vests the whole extent of the canal. Little appears to be known rela- 
tive to the intimate nature of diseases of muscular fibre, except what 
relates to derangement in its functions. In a muscular investment of 
a cavity, the principal deviations from the healthy state, according to 
our author appear to be the following: — 

"A morbidly increased but uniform and harmonious action. This appears to 
arise chiefly from causes of irritation applied to the internal surface of such ca- 
vities. In this manner we see vomiting- produced by various irritations applied 



Abercrombie on Diseases of the Stomach, fyc. 125 

to the stomach, and diarrhoea by similar causes applied to the intestinal surface. 
A similar effect seems to arise from a morbid irritability of the surface itself, 
provided it be uniform over a considerable extent of the membrane; the ordi- 
nary stimuli producing in this case the same effect that the irritating causes do 
in the other. 

"A morbidly increased but partial and irregular action. This appears to arise 
chiefly from morbid irritability of small portions of the internal surface; the or- 
dinary stimuli producing at these parts an increased action, with which the other 
parts do not harmonize. This appears to be the state which is often expressed 
by the indefinite term spasm. It is seen in the urethra and oesophagus, in the 
affection which is called spasmodic stricture, and a similar condition appears 
to occur in the bowels, particularly in certain cases of dysentery, in which we 
find morbid discharges from the lower part of the canal, with retention of the 
natural faeces in the parts above. 

" Diminution or loss of muscular power. In a muscular covering investing a 
cavity, this appears to arise from two causes, namely, over-distention, and in- 
flammation. The former we see distinctly take place in the bladder, and there 
is reason to believe that something similar occurs in the bowels in certain states 
of ileus. Inflammation seems also to destroy the action of muscular fibre. Thus 
intestine which has been highly inflamed is generally found in a state of great 
distention, showing the complete loss of its healthy muscular action; and, if 
the disease has gone on until the intestine has either become ruptured or has 
given way by ulceration, it is found to have fallen together like an empty bag, 
without any appearance of muscular contraction, whereas healthy intestine, when 
it is empty, contracts uniformly into a round cord." 

Another result of inflammation upon muscular fibre is gangrene, 
which, when found in the intestinal canal, affords strong reason to 
conclude that inflammation has existed in the muscular coat. It is, 
however, probable that gangrene may occur in each of the coats sepa- 
rately, without affecting the others, but giving rise to most impor- 
tant diversities in the symptoms. 

The fourth and last deviation from a healthy state which our au- 
thor mentions as occurring in the muscular coverings of cavities, is 
a thickening, described by French writers under the name of hyper- 
trophia. By some of these, however, the term has been applied so 
as to designate a general thickening of all the coats. 

The principal morbid affections of the mucous membrane are- 
Inflammation and its consequences. The effect of the lowest de- 
gree of this appears to be simply an increase of its proper secre- 
tion, more or less changed in its qualities from the healthy condition. 
In another state of inflammation, we find the formation of aphthous 
crusts, and in a third the deposition of false membrane. This last 
is most frequently observed in the bronchial membrane, though it is 
also occasionally met with in the mucous tissue of the intestines. In 
a more advanced stage, inflammation of the intestinal mucous coat 



126 Abercrombie on Diseases of the Stomach, fyc. 

terminates by softening or an ash-coloured pulpy degeneration of por- 
tions of the membrane; these fall out and leave spaces which are apt 
to pass into ulceration. Other alterations produced by acute diseases 
are mentioned by our author, but we shall proceed to notice those 
connected with the chronic forms of inflammation, chiefly indicated 
by an increased morbid secretion, kept up during a long period. 
" The membrane," he says, "is apt in such cases to become thicken- 
ed and even indurated, so as considerably to diminish the capacity of 
the cavity. In this manner is formed stricture of the urethra, and 
diminution of the area of the intestinal canal." 

"The follicles appear to be liable to a vesicular or pustular dis- 
ease, which passes into small, defined, distinct ulcers, quite uncon- 
nected with any disease of the mucous surface." The cardia, pylo- 
rus, and rectum afford the most usual seats for affections of a tuber- 
culous character, probably seated in the follicular or glandular struc- 
ture. In these situations they frequently assume a scirrhous cha- 
racter. 

The parts concerned in the absorption of the alimentary matter are 
sometimes so diseased, that although elaboration takes place in the 
usual manner, the chyle may pass off without entering the circulation. 
Disease of the mesenteric glands is the cause most familiar to us; but 
the same effect appears to result from certain conditions of the sur- 
face of the mucous membrane itself. 

Morbid affections of the stomach our author has arranged and 
treated of under three heads or classes. The first includes those of 
an inflammatory kind, with ulceration and its consequences. The 
second embraces those denominated organic affections, and the third 
functional disorders, including dyspepsia. 

He regards the disease commonly described under the name of 
acute gastritis, as extremely rare in an idiopathic form, unless pro- 
duced by the action of acrid poisons, and observes that he has often 
been astonished to find how seldom he had met with signs of inflam- 
mation in the stomach, even when the organs most nearly connect- 
ed with it had been inflamed in the highest degree. He considers 
the mucous membrane as the chief if not the entire seat of gastritis, 
which even in this situation is extremely rare as an acute or idiopa- 
thic disease. It is of the greatest importance that those who make ob- 
servations upon this subject, should be well versed in the signs indi- 
cating the healthy and morbid states of the textures which are the 
seats of disease. Without some standard to which the appearances 
observed may be referred, the conclusions drawn from dissections 
will often tend to confuse and embarrass pathology. In this country 



Abercrombie on Diseases of the Stomach, #c. 127 

much valuable light has been shed upon these points by Dr. Horner, 
to whose experimental inquiries and observations relative to the 
healthy and diseased appearances of the mucous membrane of the 
stomach and intestines, we would call the attention of all interested 
in the cause of a rational pathology.* 

The difficulty of establishing the positive diagnostics of inflamma- 
tion, has created great confusion in the treatment of gastric affec- 
tions, symptoms closely resembling those attendant on active inflam- 
mation, having often been found speedily yielding to a treatment 
which would generally be esteemed highly dangerous in acute gas- 
tritis. 

Without dwelling upon the symptoms of acute gastritis enumerated 
by our author, we shall proceed to notice another affection of the organ 
which he views as of much practical importance, namely, inflammation 
advancing slowly and insidiously into a chronic form, passing into ul- 
ceration, and assuming the characters of organic and hopeless disease. 
In the early stages of this affection, the prominent symptoms are of- 
ten such as merely indicate derangement of the functions of the sto- 
mach, and are apt to be included under the general term dyspepsia. 
We shall notice a few of the symptoms of this affection which may 
perhaps be looked upon as the most decisive. Pain in the region of 
the stomach, various in degree, and mostly complained of only after 
eating, remaining with severity whilst digestion is going on, and sub- 
siding with the completion of that process. The patient is on this ac- 
count reluctant to take food, and apt to make use of such an expres- 
sion as "I should be quite well if I could do without eating." In 
other eases there is no actual pain complained of, but a feeling of 
uneasiness and heat, and a great degree of pyrosis, the formation of 
an acrid fluid, and the conversion of every species of diet into in- 
tense acidity. Vomiting is an occasional attendant, but in the forms 
of this insidious disease there is great diversity in the symptoms. 
In a practical view, the most important varieties under which this 
ulceration of the inner surface of the stomach presents itself are the 
following: — 

" 1. A small defined ulcer of limited extent, with evident loss of substance, 
and rounded and elevated edges, varying in extent from the size of a split pea 
to that of a shilling. We may find only one such ulcer, every other part of the 
stomach being in the most healthy state; or we may find that there has been a 
succession of them, some of them cicatrizing, and others appearing, while the 

* See Vol. I. No. I. of this Journal. 



128 Abercrombie on Diseases of the Stomach, fyc. 

health of the patient gradually sunk under the disease, which after all may be 
found to have been of no great extent." 

" 2. Ulcers like the former, of small extent, perhaps the size of a shilling, 
but complicated with thickening and induration of the parietes of the stomach, 
perhaps to the extent of a crown-piece or more around the ulcer, all the rest 
of the stomach being perfectly healthy." 

"3. Extensive irregular ulceration of the inner surface of the stomach, gene- 
rally complicated with thickening and induration of the coats, and fungoid ele- 
vations." 

Our author remarks that in some cases there is no actual ulcera- 
tion, the prominent morbid appearance being a thickened state of the 
mucous membrane to a greater or less extent. The thickened portion in 
this case may be of a pale ash colour, or of a brown colour, or of a dark 
colour, with the characters of melanosis. He notices other complica- 
tions of this disease, and remarks that there is much variety in its 
terminations. It may prove fatal by gradual exhaustion, by haemor- 
rhage from the ulcer, by perforation of the coats of the stomach, the 
contents escaping into the peritoneal cavity and producing peritoni- 
tis. These observations are illustrated by a selection of interesting 
cases, setting forth the progressive symptoms, and the morbid appear- 
ances after death. 

A French writer, M. Gerard, has published a memoir upon this 
subject, entitled, " Des Perforations Spontanees de PEstomac. " Se- 
veral cases are described by Dr. Crampton and Mr. Travers, in 
the Medico-Chirurgical Transactions, and by M. Ebermaier, in the 
Journal Complementaire, July, 1828.* 

If the disease can be detected through its difficult diagnosis, our 
author recommends a treatment adapted to an early period, consist- 
ing chiefly of free and repeated topical bleeding, followed by blister- 
ing, issues, or the tartar emetic ointment. The food must be very 
small in quantity, and of the mildest quality, chiefly or entirely of 
farinaceous articles and milk, with total absence from all stimulating 
liquors. Distention of the stomach, even by the mildest articles, 
should be carefully avoided. Bodily exercise, so useful in dyspepsia, 
must be refrained from, and hence the importance of endeavouring 
to distinguish between the two affections. Little internal medicine 
is thought proper, except what is just sufficient to regulate the bowels. 
But in the more advanced stages the treatment must be changed, the 
external applications laid aside, and internal remedies resorted to. 

* See Vol. III. p. 452, of this Journal, and also the Periscope of the present 
number, article Pathology. 



Abercrombie on Diseases of the Stomach, 4*c. 120 

Among these he mentions the oxide of bismuth, lime water and nitric 
acid, small opiates, combined with articles of a mucilaginous nature, 
astringents, such as kino, alum, and rhatany root, the arsenical so- 
lution, small quantities of mercury, as also of nitrate of silver, and 
especially the sulphate of iron. The author has left the choice and 
adaptation of these articles to the discrimination and judgment of 
the practitioner, and we infer, from the heterogeneous assortment of 
remedies presented, that his methodus medendi is founded upon 
the most obscure views. He thinks it yet remains somewhat doubt- 
ful whether the disease admits of a cure after it has advanced to 
ulceration, for, when cases terminate favourably, the previous ex- 
istence of ulceration cannot be ascertained with certainty. That ci- 
catrization can take place in the mucous membrane of the stomach, 
ample proof is afforded, by cicatrices being found in it after death. 
These, however, have been observed in cases where the disease has 
terminated fatally. It is plain that our author's views in relation to 
this subject are far from being clear. 

Among other modifications assumed by inflammatory affections of 
this tissue lining the superior portions of the alimentary canal, seve- 
ral are worthy of particular notice. An inflammatory condition of 
the whole course of the mucous membrane, from the pharynx down- 
wards, Dr. Abercrombie thinks sometimes occurs as an idiopathic af- 
fection, though most generally observed at an advanced stage of other 
diseases, as simple fever, pneumonia, or other phlegmasia. Without 
discussing the claims which might entitle this affection to rank as 
an idiopathic or symptomatic form of disease, we shall simply quote 
the description given of it by our author. 

" There is," says he, " a peculiar rawness and tenderness of the whole mouth 
and throat; often with a dry and glazed appearance of the tongue, a deep red- 
ness of the pharynx, interspersed with aphthous crusts? and in some cases, the 
whole pharynx presents one continued dense crust of an aphthous character. 
There is generally tenderness on pressure in the epigastric region, with un- 
easiness in swallowing along the whole course of the oesophagus, and great un- 
easiness in the stomach, excited by the mildest articles of food or drink. In 
some cases this is immediately communicated to the bowels, and the articles 
speedily pass off by a rapid diarrhoea. In some cases vomiting takes place, and 
in others, both vomiting and diarrhoea." 

The remedy which Dr. A. has found most useful in his practice, 
is lime water, either alone or mixed with an equal quantity of a strong 
decoction of quassia. Small opiates he says are required. The food 
ought to be of the mildest description, but if indications of sinking ap- 
pear, wine or brandy should be given, mixed with arrow root. 

No. VII.— May, 1829. 17 



130 Abercrombie on Diseases of the Stomach, fyc. 

Our author thinks that the aphthous affection of the mouth and 
throat which attacks and sometimes proves fatal to infants, has some 
alliance to the diseased condition of the mucous membrane just de- 
scribed, and that it is moreover often found connected with minute 
ulcers of the mucous membrane of the intestine. 

The affection, to which the French have given the name of dipthe- 
rite, is another modification of disease in the mucous membrane of 
these parts. This has appeared in Europe as an epidemic, chiefly 
attacking children. 

" The first symptom is a deep redness of the tonsils or velum, without swell- 
ing or ulceration, but with the formation of aphthous crusts which are generally 
of a pure white colour. When these crusts are either removed or drop off spon- 
taneously, the membrane beneath is seen to be deeply red without breach of 
surface, and the crust is reproduced in a few hours. We find usually excoria- 
tion, or very minute ulcers along the inner membrane of the cheeks and lips, 
and a painful excoriation of the nose, often sponginess and bleeding of the 
gums; and, in some cases, the whole mouth becomes inflamed in a manner re- 
sembling the effects of mercury. There is in general little fever, but great pros- 
tration of strength, and often a diseased state of the whole system." 

The absence of ulceration will serve to distinguish it from cynanche 
maligna, and the sore throat of scarlatina. Sometimes this disease is 
slight, at others rapidly fatal, especially when it extends to the la- 
rynx. Indeed, on gaining this situation, our author thinks that its 
course is but little controlled by medical treatment. Under these 
circumstances his chief reliance is placed upon the free use of calo- 
mel, combined with occasional opiates. General bleeding cannot 
usually be borne, and blisters are apt to become gangrenous. Wine 
is sometimes necessary to support the strength, and the mineral and 
vegetable acids have been thought useful. When the stomach has 
been affected, bismuth or lime-water, with small opiates, are recom- 
mended. M. Bretonneau, who has treated of this affection at great 
length, in a work entitled "Des Inflammations Speciales du Tissu 
Muqueux," trusts chiefly to the free use of calomel, and touches the 
fauces by means of a sponge, with a mixture of equal parts of honey 
and hydrochloric acid. A similar mode of treatment has been found 
of advantage in some cases apparently of the same nature that have 
occurred in America.* 

Our author notices in this part of his work, another affection, dif- 
fering entirely from those which have been the subjects of the preceding 
observations; namely, the appearance of a soft gelatinous or pulpy 

* In the Edinburgh Journal of the Medical Sciences for October, 1826, there 
is a paper upon this disease by Dr. Hamilton, jun. 



Abercrombie on Diseases of the Stomach, fyc. 131 

degeneration of the substance of the stomach observed after death, 
when part of the softened portion is commonly found to have fallen 
out, leaving an opening with the surrounding parts in a thin state, 
and partially softened, but in general without any appearance of in- 
creased vascularity. The perforation is in some cases very large; in 
others, there are four or five perforations, separated by narrow por- 
tions in a partially softened state; and, frequently, there is no actual 
perforation, but merely a considerable extent of the stomach much 
softened, which tears upon the slightest touch. This appearance was 
noticed by Hunter, who ascribed it to the solvent power of the gas- 
tric juice. In some cases it seems to have been preceded by disease 
of the stomach, whilst in others there have been no grounds for anti- 
cipating any such affection. Upon the whole, our author inclines to 
the belief that the affection takes place after death. Nearly the same 
observations may be applied to what the French writers have denomi- 
nated remollissement of the stomach, an interesting memoir upon 
which has been published by M. Louis. 

Among other affections embraced by our author under the separate 
head of "Organic Diseases of the Stomach," are, induration and 
thickening of the coats of the stomach, and diseases seated in the 
pylorus and cardia. In the first, the disease sometimes consists of 
a uniform hardness, with the characters of scirrhus, or almost carti- 
lage; in others, it has more the appearance of a mass of tubercular 
disease, and frequently, a considerable mass of tumours projecting 
from it internally, is of a soft texture resembling the substance of the 
brain. 

Disease of the pylorus, though liable in its first periods to be con- 
founded with other gastric affections, is in its more advanced stage 
generally to be distinguished by periodical vomiting, occurring at 
intervals after meals, commonly accompanied with some fixed unea- 
siness in the region of the stomach. Sometimes induration can be 
felt externally. But extensive disease of this locality has been found 
after death where these and other characteristic symptoms had not 
previously existed. Our author relates cases illustrating the progress 
and termination of this scirrhous affection seated in both the orifices 
of the stomach. It appears very probable that the duodenum is occa- 
sionally the seat of affections which are mistaken sometimes for those 
of the stomach and liver. The leading peculiarity of disease in this 
portion of the intestinal canal, is that the food, taken with a relish, oc- 
casions no inconvenience until it begins to pass out of the stomach, 
an hour or two after a meal, at which time the pain is often felt with 
great severity, and may continue for several hours, generally extend- 



132 Abercrombie on Diseases of the Stomach, fyc. 

ing obliquely backwards in the direction of the right kidney. For 
a good illustration of the peculiar characters of disease of the duode- 
num, Dr. Abercrombie refers to a case related by Dr. Irwin, and 
published in the Philadelphia Journal for August, 1824. 

In the next section our author introduces us to the familiar, may 
we not say almost threadbare, subject of dyspepsia, considered as a 
morbid derangement of the function of digestion, unconnected with 
any change of structure, either of the stomach itself, or of the parts 
adjacent. The dependence of the digestive process upon the influence 
of the eighth pair of nerves, he justly considers one of the most inte- 
resting discoveries made by modern physiologists. But although it 
has not yet led to any important practical results, we still think that, 
like many other recently demonstrated facts, it is destined to play, 
at some future period, an important part in the system of inductive 
medicine. 

The functional derangements of the stomach mentioned by our au- 
thor as the least conjectural, are the following: 

Deficient action in the muscular coat, occasioning too long a deten- 
tion of the alimentary matters, followed by imperfect changes and 
chemical decompositions. A morbidly irritable state of the mucous 
membrane leading to excitement of the muscular coat, and producing 
an evil precisely the reverse of that just mentioned, namely, either 
speedy rejection of the food by vomiting, or its propulsion downwards 
in a half digested state. Deficiency in the quantity, or alteration in 
the qualities of the fluids of the stomach. 

Some of the most important rules laid down by Dr. A. for the 
treatment of dyspepsia, are the following. Regarding the muscular 
action of the stomach as more vigorous when the contents are in 
small quantity than when there is much distention, and supposing 
that the secretions are regulated by the quantity of ingesta they have 
to act upon, he lays it down as the first and great principle in the 
treatment of indigestion, that the quantity of food should be restrict- 
ed so that no more shall be taken than the stomach is found capable 
of digesting in a healthy manner. It is found that the digestive process 
is carried on slowly, particular care should be observed not to take 
additional food until full time has been allowed for the solution of the 
former. If, for instance, the healthy period be four or five hours, the 
dyspeptic should probably allow six or seven. This is one of our au- 
thor's golden rules, which is on no account to be infringed upon by 
the opposite course of breakfast, lunch, and dinner, all within the 
space of seven or eight hours. The quality of the articles taken as 
food, though usually regarded as the most essential consideration in the 



Abercrombie on Diseases of the Stomach, fyc. 133 

treatment of dyspepsia, Dr. A. considers a minor consideration when 
compared to the importance of quantity. In fact, he thinks that the 
dyspeptic might be almost independent of any attention to the quality 
of his diet, if he rigidly observed the necessary restrictions in regard 
to quantity. " It is often," he continues, " remarkable, how articles 
which cannot be borne as a part of mixed diet, agree perfectly when 
taken alone; how a person, for example, who fancies that milk disa- 
grees with him, will enjoy sound digestion upon a milk diet; and how 
another, who cannot taste vegetables without being tormented with 
acidity, will be entirely free from acidity on a vegetable diet. " For 
ourselves, we think that the diet in these affections should be regu- 
lated by the state of the mucous membrane of the stomach. Sometimes 
the irritation in this amounts almost, if not absolutely to inflamma- 
tion, in which case animal food, though generally agreeing best with 
dyspeptics, would prove highly injurious, and the diet should be re- 
stricted entirely to rice water, rice jelly, thin arrow-root, or bread 
and milk, according to circumstances, with a total abandonment of 
every thing stimulating, either solid or fluid. 

In the medical treatment of dyspeptic complaints, our author pre- 
fers for the purpose of counteracting the usually slow motion of the 
bowels, a combination of columbo powder with carbonate of potass 
and a few grains of rhubarb, to be taken once or twice a day. He 
likewise recommends as tonics the use of sulphate of iron with aloes; 
the sulphate of quinine with aloes; oxide of bismuth, with rhubarb or 
aloes; and in particular the nitric acid, which, he observes, is often 
found one of the best correctors of acidity. Benefit is also derived 
from the other mineral acids and lime water. He very properly con- 
demns the free use of stimulants, active purging, and the indiscrimi- 
nate employment of mercury, which last remedy he would only admit 
of where there appeared to exist some derangement of the liver. 

In the various forms of that unpleasant occasional attendant upon 
dyspepsia, gastrodynia, or pain in the stomach, our author says that 
he has found nothing of more general utility than the sulphate of 
iron, in doses of two grains, combined with one grain of aloes, and 
five grains of aromatic powder, taken three times a day. This of 
course is not of universal application, for the causes being various, 
must call for variety in the treatment. A modification of this affec- 
tion met with in persons of a gouty habit, seems in general to be 
most relieved by stimulants combined with alkalies and small opiates. 
He, however, recommends caution to be observed in this course, since 
the cases may be connected with chronic inflammation or ulceration, 
when the consequences might be fatal. 



1 34 Abercrombie on Diseases of the Stomach, fyc. 

Passing by some other troublesome affections introduced under this 
head, we shall submit a few of our author's observations relative to 
sympathetic affections of the heart, which assume such various forms, 
and frequently counterfeit so closely the character of organic diseases 
of the heart and large blood-vessels, as to create great alarm, and 
render discrimination very difficult. 

" The slightest, and perhaps the most common form consists of a momentary 
feeling of a rolling or tumbling motion of the heart, like that produced by a 
sudden surprise or fright, and it is accompanied by an intermission of the pulse. 
This feeling may be repeated only once or twice at a time, and occur at long 
intervals; or it may return in rapid succession, for half an hour or an hour to- 
gether; or it may be felt occasionally at irregular intervals, for several days or 
weeks, or for a still longer period." 

Various other feelings, such as palpitation, irregular action of the 
heart, and even dyspnoea are perceived, but we shall proceed to state 
some of the principal diagnostic symptoms by which these affections may 
be distinguished from real diseases of the heart. A dyspeptic origin 
is indicated by the regular and natural action of the pulse and heart 
during the intervals between the attacks, relief from remedies direct- 
ed to the state of the stomach, the symptoms being most apt to occur 
whilst the patient is at rest, and especially after meals, and being re- 
lieved instead of increased by active bodily exercise. Our author 
has given several highly interesting cases of this affection. 

Some other disorders, which, from their situation and nature, ap- 
pear allied to those of the stomach, are described in an appendix to 
this chapter. Among these are diseases of the oesophagus, and espe- 
cially the various forms of dysphagia or difficult deglutition. The most 
frequent causes of this last affection according to our author, are — 
enlargement of the epiglottis, and diseases of the larynx, generally 
distinguished by very slight cough and difficulty of breathing. — Para- 
lysis of the oesophagus, generally connected with disease of the 
brain or spinal chord, characterized by a sudden and complete loss 
of the power of swallowing, whilst a full sized probang might 
be passed without difficulty. The cases he observes generally 
got well soon, and in some of them electricity was extremely bene- 
ficial. One patient could not for some time swallow at all, except 
when he was seated on the electrical stool. — Simple stricture of the 
oesophagus, generally connected with a thickening of the mucous 
membrane at a particular spot, without disease of the other coats. — 
Contraction, with more extensive disease, as thickening and indura- 
tion of the coats of the oesophagus, frequently combined with ulcera- 
tion of the inner surface. —Tumours external to the oesophagus, 



Abercrombie on Diseases of the Stomach, fyc. 135 

formed by enlargement of the bronchial glands, or those of the pos- 
terior mediastinum. — Polypous tumours growing from the inner sur- 
face of the oesophagus itself. — Collections of matter behind this tube, 
sometimes to an immense extent. — Aneurism of the aorta. — Disease of 
the cardia. — Morbid irritability of a part of the mucous membrane, 
probably giving rise to the form rather indefinitely denominated spas- 
modic stricture. 

As the treatment of these numerous forms must be adapted to the 
various existing causes, the subject would be much too long to intro- 
duce here. "We shall therefore proceed to another division of our 
author's book, wherein he treats of affections of the intestinal canal. 

The leading pathological principles quoted at some length in the 
beginning of this article, are to be steadily kept in view during the 
consideration of diseases of the intestinal canal. The symptoms con- 
nected with inflammatory affections of these tissues in the abdomen 
are an irritable state of the bowels, assuming the characters of diar- 
rhoea, cholera, and dysentery, denoting the mucous membrane to be 
the chief seat of disease; obstruction of the bowels, showing the affec- 
tion to be seated in the muscular coat; whilst inflammation may exist 
in the peritoneal coat alone, and proceed to a fatal termination, the 
functions of the bowels continuing in a natural state through the whole 
course of the disease. 

Our author considers diseases of these parts under the following 
divisions or heads: 1. Ileus; 2. Inflammatory affections of the more 
external parts, including peritonitis and enteritis; 3. Diseases of the 
mucous membrane. But as these affections are often more or less 
combined, their consideration must consequently be connected. 

He thus describes the first-mentioned disease: — 

"Colic and ileus are different degrees or different stages of the same affec- 
tion, and the name, therefore, may apply to both. The symptoms in the early 
stages are pain of the bowels, chiefly twisting with great severity round the um- 
bilicus, obstinate costiveness, and generally vomiting; but without fever, and 
commonly at first without tenderness, the pain on the contrary being rather re- 
lieved by pressure. As the disease advances, and if no relief be obtained, the 
abdomen becomes tense, tender, and tympanitic; the vomiting very often be- 
comes stercoracious, with severe tormina, intense suffering, and rapid failure of 
strength. In this manner the disease may be fatal without inflammation, or at 
an advanced period it may pass into inflammation, and be fatal by extensive 
gangrene." 

He investigates the conditions of the parts affected in the several 
states and stages of the disease, illustrating the various forms by a 
series of highly interesting cases, in which both the symptoms and ap- 
pearances on dissection are detailed. Some of the pathological and 



136 Abercrombie on Diseases of the Stomach, fyc. 

practical deductions drawn from these sources, we shall proceed to 
state in a summary manner. 

" At the earliest period at which we have an opportunity of seeing the con- 
dition of the parts in a fatal case of ileus, it seems to consist in a state of simple 
distention, without any visible change in the structure of the part." 

When life has been prolonged to a rather more advanced period of 
the disease, a tinge of vivid redness is found on the distended part of 
the intestine. In another stage, the distended portion presents a 
leaden or livid colour, without any sensible change of texture, which, 
however, at a still later period seems to pass into gangrene. All these 
appearances, our author thinks, commonly have their seat in the mus- 
cular coat, and may exist independently of peritonitis, although this 
may be combined with ileus in its more advanced stage. 

As post mortem examinations of subjects that have died of ileus 
generally show some part of the intestine in a state of great disten- 
tion, and another empty and collapsed, nearly in the form of a chord, 
a question has arisen which of these parts was to be looked upon as 
the true seat of the disease. Some have contended that a spasmodic 
contraction has occasioned distention of the parts above, but our au- 
thor, rejecting the doctrine of spasm as applied to this subject, ad- 
duces many considerations in support of his opinion that the real seat 
of disease is in the distended portion, the other being a healthy con- 
dition of the bowel. 

Some of the practical deductions furnished by Dr. A. are as follows. 
Pain increased by pressure he does not always look upon as a certain 
mark of inflammation in the bowels, since various observations have 
satisfied him that intestine which has become rapidly distended is 
painful upon pressure, although this kind of pain can by attention ge- 
nerally be distinguished from the tenderness of acute inflammation. 

Sudden cessation of pain, and sinking of the vital powers, he thinks, 
are not necessarily indications of internal gangrene, since he has seen 
these symptoms existing with recent inflammation, and on the other 
hand, he has met with cases where there was extensive gangrene, 
although violent pain continued to the last. 

He thinks the pulse a very uncertain index of the condition of the 
parts in ileus, it having appeared less affected in some cases where 
signs of considerable inflammation were observeable after death, than 
in others where none were met with. 

Ileus, he observes, does not appear to be necessarily connected 
with feculent accumulation, or with any condition of the contents of 
the canal, it being sometimes fatal where the appearances are natu- 
ral, or almost fluid, or in very small quantity. Neither does it appear 



Abercrombie on Diseases of the Stomach, #c. 137 

to be necessarily connected with obstruction in any part of the canal, 
since fatal cases occur without, and death has ensued after every 
thing like obstruction has been entirely removed. He gives a cau- 
tion against forming a favourable prognosis in ileus from the appear- 
ance of feculent evacuations, since these may be dislodged from the 
lower and healthy portions of the intestine, while the disease above 
remains unchanged. 

The first point Dr. A. recommends to be observed in entering upon 
the treatment of ileus, is to ascertain by accurate examination whether 
hernia exists, since this affection may be present without the patient 
being aware of it, and though so very small as to include only a minute 
portion from one side of the intestine, may yet, he says, be the cause 
of fatal disease. 

The symptoms to be more particularly kept in view in the treat- 
ment of ileus are: — 

" 1st. Obstinate costiveness with distention of the abdomen, and considerable 
general uneasiness, but without tenderness or much acute suffering". 

"2d. The same symptoms combined with fixed pain and tenderness, referred 
to a denned space on some part of the abdomen, frequently about the head of 
the colon. 

"3d. Violent attacks of tormina, occurring in paroxysms, like the strong" im- 
pulse downwards from the action of a drastic purgative; the action proceeding* 
to a certain point, there stopping" and becoming inverted, followed by vomit- 
ing, the vomiting often feculent." 

In considering the practical application to be drawn from the above 
classification of symptoms, he discusses the important question, 
whether the operation of purgatives is advantageous or hurtful in 
ileus. Some cases, he observes, yield at first to a powerful purgative, 

whilst in others again, such a course appears highly injurious. 

• 

" A large dose of calomel will frequently settle the stomach, and move the 
bowels; but upon the whole, I think the best practice in general is the repeti- 
tion at short intervals of moderate doses of mild medicines, such as aloes, com- 
bined with hyoscyamus." 

We must confess our surprise at the mild prescription of Dr. 
Abercrombie, having always looked upon aloes as an energetic pur- 
gative, acting with particular force upon the large intestines, which 
it often irritates in a high degree. Viewing this article as only adapt- 
ed to atonic conditions of the intestinal canal, we would carefully 
refrain from its use whenever we apprehended a highly irritated 
or inflamed state of the large intestines. The advantages derived 
from calomel in ileus we look upon as less equivocal, and are dis- 

No. VII.— May, 1829. 18 



138 Abercrombie on Diseases of the Stomach, fyc. 

posed to ascribe them in part or altogether to some peculiar quali- 
ties in this metalic preparation, which we have often seen applied to 
external inflammations with the effect of allaying them. But it must 
not be forgotten that great inconvenience and danger often arises 
from the free internal use of calomel, especially when it has been 
long retained in the bowels. It appears very remarkable to Dr. A. 
that there are cases of ileus which yield to a full dose of opium after 
the most active purgatives have been tried in vain. Now, to us, this fact 
does not seem at all inexplicable, since we have witnessed over and 
over again from the external application of solutions of opium, the 
most speedy effect in soothing and allaying inflammatory affections 
of the mucous and other tissues. Why may not both opium and calo- 
mel be as useful in allaying inflammation when seated internally as 
when existing externally. 

The other remedies on which our author places reliance are, blood- 
letting, which should be resorted to in every case of ileus, unless dis- 
tinctly contraindicated by the age or habit of the patient, the relief 
being often so immediate that there is scarcely time allowed to tie up 
the arm, or get the patient out of bed before complete evacuation 
takes place. — The tobacco injection, administered atfirst with extreme 
caution, perhaps not more than fifteen grains, infused for ten minutes 
in six ounces of boiling water, repeated if necessary in the course of 
an hour, in the quantity of twenty grains, and so on till slight giddi- 
ness and muscular relaxation take place. These precautions observed, 
no unpleasant effects need be apprehended. With this treatment he 
recommends the conjoined use of " mild purgatives, such as aloes and 
hyoscyamus, repeated in full doses every hour or two." It would, 
we think, be easy to find some really milder purgative as a substitute 
for the aloes. 

Opiates, he considered most applicable to cases characterized by 
paroxysms of violent tormina. If in such cases there be a frequency 
of pulse, and fixed pain or tenderness, a full bleeding, followed by an 
opiate, seems the best mode of treatment, the mildest means being 
afterwards generally sufficient to move the bowels. 

When the system begins to be exhausted in the advanced stages, 
Dr. A. recommends as proper stimulants the aloetic wine, given in 
full doses of one or two ounces, repeated about every hour. The 
tincture of aloes may likewise be given in the same manner. Nor is 
the tobacco injection to be omitted even at this late period of the 
disease. 

The other remedies he mentions are, the application of cold, either 
by dashing cold water upon the legs, the continued application of it 



Abercrombie on Diseases of the Stomach, fyc. 139 

to the abdomen by means of wet cloths or cold injections:— The 
warm bath, previous to the occurrence of inflammatory symptoms: — 
Crude mercury in doses of one or two pounds, he says he has repeat- 
edly used with the effect in some cases of allaying the vomiting, 
which appeared to be its only operation: — The forcible injection 
of a large quantity of fluid to the amount of six or eight pounds:— 
Large blisters over the abdomen: — Oil of turpentine applied external- 
ly and by injection. From the favourable termination of many cases 
deemed desperate, he recommends a steady perseverance in the me- 
dical treatment, notwithstanding the most unfavourable appearances. 

In the general division of our author's treatise, the second part is 
devoted to inflammatory affections of the more external parts of the 
intestinal canal, including peritonitis and enteritis, and as a prelude 
to their consideration, he advances the following positions: — 

1. Intestinal inflammation may be confined to the peritoneal 
coat, and run its course without interrupting the muscular action 
of the canal. 2. The inflammation may affect the peritoneal and 
muscular coats at once, in which case there will be the symptoms of 
peritonitis, combined with obstruction of the bowels, constituting the 
disease to which we give the name of enteritis. 3. Inflammation may 
be entirely confined to the mucous membrane, producing a train of 
symptoms altogether different from those which occur in the preced- 
ing cases, with a disease often running its course to a fatal termina- 
tion, without any affection of the other coats. The inflammation may, 
however, spread from structure to structure, so that simple perito- 
nitis shall pass into enteritis, whilst another affection beginning with 
diarrhoea or dysentery, may afterwards terminate by inflammation of 
the other coats. 

From numerous cases, which he details for the purpose of illus- 
trating the pathology of this class of diseases, he draws the following 
practical conclusions: — 

" 1. Extensive and highly dangerous inflammation may exist in the intestinal 
canal, without obstruction of the bowels; and it may go on to a fatal termina- 
tion, whilst the bowels are in a natural state, or easily regulated by mild medi- 
cines, through the whole course of the disease. 

" 2. No diagnosis can be founded in such cases on the appearance of the 
evacuations. These may be slimy, and in small quantity; they may be copious, 
watery, and dark-coloured, or they may be entirely natural. 

" 3. Extensive and fatal inflammation may be going on with every variety in 
the pulse; it may be frequent and small; it may be frequent and full, or it may 
be little above the natural standard through the whole course of the disease. 

"4. Extensive inflammation may go on without vomiting, and without con- 



140 Abercrombie on Diseases of the Stomach, Sfc. 

stant pain; the pain often occurring in paroxysms, and leaving long intervals of 
comparative ease. 

"5. Keeping in view these sources of uncertainty, our chief reliance for the 
diagnosis of this important class of diseases, must be on the tenderness of the 
abdomen. This symptom should always be watched with the most anxious 
care, whatever may be the state of the bowels, or of the pulse, or the actual 
complaint of pain; and though the tenderness itself should be limited to a 
defined space of no great extent; for we have seen that with every variety in 
these respects, a disease may exist of a very formidable character, and be ad« 
vancing to a fatal termination. A certain degree of pain upon pressure we 
have found attending a merely distended state of the intestine; but this differs 
from the acute sensibility of peritonitis in such a degree that an attentive prac- 
titioner can in general have no difficulty in making the distinction. When the 
tenderness exists without distention, as is frequently the case in the early stages 
of peritonitis, there can be no difficulty in the diagnosis.*' 

Without entering into a particular description of the symptoms at- 
tending upon peritonitis and enteritis, we shall briefly refer to a few 
of the diagnostics noticed by Dr. Abercrombie. A leading peculiarity 
in peritonitis is that the bowels are not obstructed, being either na- 
tural or easily moved by mild medicines; but these evacuations are 
not attended with the relief expected. The pulse is commonly less 
affected in the early stages than it is in enteritis, being perhaps 
from eighty to ninety or ninety-six, and oftentimes little above the 
natural standard. Peritonitis also differs from enteritis, in having 
the pain occurring in paroxysms, and in the absence of vomiting. 
These symptoms relate only to the early stages, for as the disease 
advances, the pain becomes more fixed, and the usual characters of 
enteritis make their appearance. 

Enteritis differs from simple peritonitis chiefly in being attended 
with vomiting and obstinate obstruction of the bowels. The pulse is 
in general more frequent and small, and the pain more violent and 
constant, often resembling the tormina of ileus. This, however, our 
author tells us is not inyariably the case; enteritis being on the con- 
trary, sometimes chiefly characterized by fever, with urgent vomit- 
ing and obstruction of the bowels, and tenderness of the abdomen, 
but without much complaint of pain. 

From his general outline of the treatment of intestinal inflamma- 
tion, we shall make a few extracts. Blood-letting, which, in accord- 
ance with the general opinion, he considers the most important of the 
general remedies, he recommends to be pushed to a great extent in 
all cases of active inflammation at an early period, and further ad- 
vises in all urgent cases, that full bleedings be followed up by small 



Abercrombie on Diseases of the Stomach, fyc. 141 

ones repeated at short intervals, when the effects of the others 
begin to subside. " The inflammation of a vital organ," says Dr. A. 
" should not be lost sight of above an hour or two at a time, until the 
force of it be decidedly broken; and, unless this take place within 
twenty-four hours, the termination must be considered as doubtful." 
Our author regards purgatives in enteritis as hurtful, if administer- 
ed before the inflammation has been subdued, and states that he has 
seen their action immediately followed by a renewal of the inflamma- 
tory symptoms. That they may and do act under these circumstances 
as irritants we fully believe, as may be inferred from what we have 
already said relative to their use in ileus. Independent, therefore, 
of the difficulty of making them remain on the stomach, we look upon 
purgatives as forming quite a secondary part in the treatment of acute 
enteritis. When called for in the latter stages of the disease, the very 
mildest should be preferred, not only from their occasioning the least 
irritation, but from their usually operating more promptly and effi- 
ciently than those of an active kind. Mild injections are highly use- 
ful auxiliaries. 

In cases where, after the inflammatory symptoms appear to have 
been subdued, the pulse has continued frequent, Dr. A. says the 
digitalis may be given very freely with much advantage. 

Before concluding our remarks upon intestinal inflammations, we 
shall notice an affection frequently attending upon them, namely, tym- 
panitis. This may occur in the early stages of enteritis, from a tempo- 
rary derangement of the muscular action, and may subside along with 
the inflammation. But at a more advanced period of the disease, it 
must be looked upon with much anxiety; for if it occur before the in- 
flammation is subdued, it is generally a fatal symptom, denoting a 
complete loss of the tone of the bowels, and the existence of extensive 
adhesions. Tympanitis may, however, exist after the inflammation 
has subsided, from a mere partial loss of tone, in the intestinal coats, 
and under these circumstances the patient recover. The treatment 
recommended for this affection by our author, consists chiefly in the 
administration of small quantities of wine or brandy at short inter- 
vals; gentle compression and friction of the abdomen; injections of 
beef-tea; to which may be liberally added bark or sulphate of qui- 
nine, turpentine, tincture of assafcetida, and a moderate quantity 
of laudanum. These should be repeated every two or three hours, 
Laxatives are to be used with caution. He recommends for this 
purpose the aloetic wine. That most formidable affection which has 
been called the true tympanitis abdominalis, can scarcely be con- 
sidered as under the control of medicine, arising as it does from per- 



142 Abercrombie on Diseases of the Stomachy fyc. 

foration of the intestine and the escape of flatus into the peritoneal 
cavity. 

As the inflammation in peritonitis sometimes assumes erysipelatous 
characters, Dr. A. has made this form the subject of a distinct chapter. 
In a pathological point of view, he considers the chief feature of this 
affection its termination ordinarily by effusion of fluid, without much, 
and often without any of that inflammatory and adhesive exudation, 
so characteristic of the more ordinary forms of peritonitis. The 
effused fluid is sometimes a bloody serum or sanies, occasionally 
mixed with a little pus, which subsides to the bottom of the vessel 
when the fluid is left at rest. In other cases it is milky or whey- 
coloured, or contains shreds or flaky matter. Occasionally it has 
all the characters of pus. 

This affection is remarkable for the rapidity with which it runs its 
course, a sudden sinking of the vital powers sometimes occurring at 
a period so early as to prevent the adoption of any active treatment. 
It is frequently associated with erysipelatous affections of other parts; 
and Dr. A. speaks of its appearing as an epidemic. He thinks that 
when erysipelatous inflammation attacks internal parts or organs, it 
assumes characteristics decidedly different from common acute in- 
flammation of the same parts. Women in the puerperal state are, 
he observes, liable to two distinct forms of peritonitis, which have 
not been sufficiently distinguished from each other. These are, 
acute peritonitis, presenting the usual symptoms, and another form, 
in which the symptoms are more insidious, and accompanied from an 
early period, by great prostration of strength, and fever of a typhoid 
character. 

Chronic peritonitis Dr. A. thinks of more common occurrence than 
persons not familiar with pathological investigations generally sup- 
pose. He views it as a disease of the most insidious and dangerous 
character, the symptoms being extremely obscure. To be treated 
with any chance of success, the utmost attention must be paid to its 
earliest indications, for which we refer to our author's treatise, where 
a number of cases illustrative of the disease may be found. The 
treatment recommended consists chiefly in the repeated employment 
of free topical bleeding, blistering, confinement, rest, antiphlogistic 
regimen, and the mildest diet. 

We come now to the portion of our author's work which treats of 
inflammatory affections of the intestinal mucous tissue, and shall in- 
sert a few of the practical conclusions which he has drawn relative 
to the principal diseases affecting this structure. 

"1. Active inflammation of the mucous membrane, which varies considera- 



Abercrombie on Diseases of the Stomach, fyc. 143 

bly in its characters, according* to the extent and seat of the disease. It may 
be fatal in the inflammatory stage, by gangrene, by ulceration, and by passing 
into peritonitis. 

"2. Chronic diseases of the membrane. This may supervene upon an acute 
attack, or may come on in a gradual and insidious manner without any acute 
symptoms. It generally goes on for a length of time, and is fatal by gradual 
exhaustion. Upon dissection it shows fungoid disease of the membrane, ulce- 
ration of various characters, or thickening and induration of all the coats of the 
intestine. It may be fatal more suddenly by perforation of the intestine and 
rapid peritonitis." 

Among the acute inflammations of the mucous intestinal coat, 
dysentery is the form most prevalent and fatal in this country, where, 
however, as in other places, it is often attended with little danger: 
Accompanied with fever, constitutional disturbance, or vomiting, the 
disease, our author very properly informs us, is to be watched with 
much attention. When limited, as it is in a large proportion of cases, 
to the rectum or lower part of the colon, there is generally little dan- 
ger to be apprehended, but if it be attended with pain and tender- 
ness extending above the pubis, in the course of the ascending colon, 
the case must be looked upon as more precarious. If this tenderness, 
along with tension, extend into the epigastric region, there will be 
reason to apprehend an affection of the arch of the colon, which will 
make the case still more alarming. The danger may be considered 
extreme when there is ground to believe the whole course of the large 
intestine affected, chiefly, we suppose, from the violent constitutional 
disturbance that ensues. 

In colonitis and tropical dysentery the disease extends through 
the whole of the colon, or through a considerable part of the small in- 
testines, attended with copious discharges, at times, of thin healthy 
feces, varied occasionally by mixtures of morbid discharges, and by 
articles of food or drink little changed. In that most rapid and fatal 
disorder, Indian cholera, there is reason to believe a much more ex- 
tensive affection of the intestinal canal, embracing the largest por- 
tion of the lining membrane not only of the great, but of the small in- 
testines. In this last-named disease, inflammation of the mucous 
tissue is supposed to exist in its very highest form. 

From the chapter devoted to the treatment of acute inflammations 
of the mucous membrane, we. extract the following observations ap- 
plied to dysentery. Dr. A. agrees with most practitioners of the 
present day, in respect to the great importance of general blood- 
letting in the early stage. He likewise thinks much benefit is to be 
derived from the application of leeches either to the abdomen, or, 
when the disease is seated in the lower part of the bowels, to the verge 



144 Abercrombie on Diseases of the Stomach, fyc. 

of the anus. Blistering, diaphoretics, and the antiphlogistic regimen 
are all recommended. To quiet the general irritation, and also as 
a diaphoretic, he prefers Dover's powder, or ipecacuanha, in doses 
of one or two grains, three or four times a-day. James's powder, which 
is frequently prescribed for the same purpose, he objects to, upon 
the ground that in all inflammatory affections of the mucous membrane 
of the intestines, the effects of antimonial preparations are equivocal. 
He mentions a great variety of remedies that appear useful in a more 
advanced stage, after the inflammatory symptoms have been subdued, 
such as cusparia, lime water, oxide of bismuth, nitric acid, sulphate 
of alum, logwood, balsam of copaiva, acetate of lead, either adminis- 
tered alone or variously combined; as, for example, a strong decoction 
of cusparia with nitric acid and laudanum, oxide of bismuth with 
cusparia and Dover's powder. Nitric acid combined with opiates he 
thinks may be administered with advantage even in the early stages. 
He likewise speaks favourably, from his own observation, of charcoal 
given in combination with Dover's powder. The most useful injec- 
tions, he thinks, are mucilaginous articles, or thin arrow-root, with 
an opiate, and infusion of tobacco, or of ipecacuanha, in the early 
stages, and after the subsidence of the urgent inflammatory symptoms 
to relieve the tenesmus, lime water, diluted at first with equal parts 
of milk or thin arrow-root, and with the addition of an opiate. 

He does not look upon purgatives as forming a regular or essential 
part of the treatment of dysentery, but advises the occasional use of 
the mildest laxatives, more for the purpose of obviating the bad ef- 
fects from feculent accumulations, than to act directly upon the disease. 
We think his views upon this subject highly judicious, and believe the 
very common practice of forcing the bowels into constant and inordi- 
nate action, by means of various cathartic medicines, very often ex- 
tremely injurious, by aggravating and extending the existing inflam- 
mation. They are supposed to have the effect of checking the unnatural 
secretions, and changing the appearances of the evacuations, but it 
cannot be doubted that they too often increase these by adding to the 
morbid irritation or inflammation upon which these circumstances de- 
pend. We fully agree with our author in believing that the use of 
purgatives in dysentery demands much discretion. 

In the chronic forms of disease in the mucous membrane of the in- 
testinal tract, the treatment is acknowledged by our author to be 
"precarious," and the list of remedies which he mentions as appear- 
ing generally useful, afford abundant evidence that it is so. These 
are, lime water; vegetable bitters and astringents, especially cusparia 
and logwood; preparations of iron; small quantities of mercury with 



AshwelPs Treatise on Parturition, tyc. 145 

opium, especially calomel with Dover's powder, or small doses of ca- 
lomel with opium and ipecacuanha ; the resins, as turpentine, balsam of 
copaiva or tolu, with small doses of opiates; sulphur with opium 5 nitric 
acid; various combinations of these remedies with each other. Again, 
repeated blistering on the abdomen is often very beneficial, as is also 
bandaging with a broad flannel roller, and the tepid salt water bath. 
He thinks from various trials of the medicine, that he has seen advan- 
tage result from the sulphate of copper lately recommended by Dr. 
Grenville in various protracted affections of the bowels. The doses 
mentioned are at first half a grain, combined with an equal quantity 
of opium, which may, if necessary, be increased gradually to the ex- 
tent of three grains with half a grain of opium, three times a day. In 
all affections of this kind, most rigid attention must be paid to diet. 
Animal food appears hurtful in every form, and the best substitutes 
for it are the various farinaceous preparations. 

We are compelled to pass over some other morbid affections of the 
abdominal viscera, noticed in the last pages of Dr. Abercrombie's 
extensive treatise, our analyses having already reached beyond the 
limits originally proposed. Satisfied with placing before our readers 
those observations and conclusions which bear most immediately upon 
practical points, we have waived discussion as far as possible, even 
where so many occasions inviting it presented. The whole space 
allotted to this article would have been much too small for the argu- 
ments upon the single question, whether inflammation of the gastro- 
intestinal mucous tissue be the primary source of all fevers, as main- 
tained by Broussais and others, or whether such inflammation is not 
of secondary origin. G. E. 



Art. XIV. JL Practical Treatise on Parturition, comprising the At- 
tendant Circumstances and Diseases of the Pregnant and Puerperal 
States. By Samuel Ashwell, Member of the Royal College of 
Surgeons, and the Medico-Chirurgical Society of London. To 
which are appended two Papers, the one containing some Remarks 
on Abdominal Surgery, the other on Transfusion; presented by 
Dr. Blundell, of Guy's Hospital. London, 1828, pp. 546, 8vo. 
with 13 plates. 

1 HIS work does not pretend to originality; it must be looked upon 
only as a manual of uncommon size. The author has borrowed liberally 
and judiciously from all the more recent English works upon the subjects 
No. VII.— May, 1829. 19 



146 Ashwell's Treatise on Parturition, fyc. 

on which he treats; but rather too often, perhaps, without acknowledg- 
ment. There is but too little evidence of the author being an old and 
extensive practitioner of midwifery; and the "getting up of this 
work," must have had a sinister object; for his own experience, at 
least as far as can be determined by the practical value and bearing of 
this work, does not appear to justify its publication. We are not 
sufficiently acquainted with the London modes of getting into 
business, to make a very positive assertion upon the subject, yet we 
strongly suspect from this, and many other works of modern date, 
that " making a book" is one. It was not so formerly; for, "0! that 
mine enemy might write a book," was the impassioned expression of 
the wisest of men — but with the motive for publication we have no- 
thing to do — it is certainly well " got up;" though its price is most 
unnecessarily enhanced by the introduction of Smellie's plates, as 
these plates utterly fail to answer the purposes for which they are in- 
tended; no drawings indeed, however ingeniously designed, or ela- 
borately executed, can aid the student in the application of the for- 
ceps in the slightest degree. Besides, the two first plates do not re- 
present the objects intended, at least not as they should do — but 
more of this by and by. 

We however acknowledge with pleasure, that the principles he has 
adopted are generally correct; and the practice arising out of them, 
is for the most part unexceptionable. We also admit, that the work 
is modestly written; and is free from parade, or pedantry, as well as 
from misleading speculations. 

Mr. Ashwell commences his work, according to usage, with a brief 
history of midwifery; as this occupies but four and twenty pages, much 
of interesting detail cannot be expected. He divides his subjects into 
four parts; in Part I. he treats of the " Obstetric Properties of the 
Pelvis; carefully noticing those Deviations which may obstruct Par- 
turition." 

In Chapter I. of this division, he considers the composition of the 
pelvis; the separation of its bones; its relation to the practice of mid- 
wifery; its deformities; the soft parts contained in it; and the mode 
of ascertaining its diameters. He is very concise on this part of his 
subject — which is no great error perhaps; for, as regards the healthy 
anatomical construction of the particular bones constituting the pel- 
vis, little, or nothing new or interesting, can be said. But not so 
when either may be in a state of disease; as a slight deviation from a 
proper conformation, may very materially influence the mechanism 
of labour and the mode of terminating it. 

We think that Mr. A. has given too much importance to the state 
of union between the coccyx and sacrum, when that joint alone is not 



Ash well's Treatise on Parturition, fyc. 147 

enjoying its natural or healthy powers, and from which a serious prac- 
tical error may result. He says that the "anchylosis of this bone is 
of rare occurrence; and still more rarely produces any serious ob- 
struction to parturition. We have, however, seen one case, in which 
the birth of the child was much retarded by the encroachment of this 
bone on the capacity of the inferior outlet of the pelvis." For when 
this part alone is in an unhealthy condition, all other things being 
equal, it can never cause any serious inconvenience, though it may 
perhaps create some delay in the progress of the head ; for, as Bau- 
delocque very justly observes, that when the consolidation of this 
bone with the sacrum obstructs delivery, " it is only in women who 
have also narrow pelves." We should not have stopped to notice this 
point, did not the belief of the consolidated condition of the coc- 
cyx lead to error in practice. We once knew this part fractured, 
by a practitioner who had adopted this notion, by introducing his 
finger into the rectum, and forcing the coccyx too far back — a very 
tedious and painful convalescence followed; the patient could not sit, 
but upon an open seat, for many months after this ill-judged inter- 
ference. 

* We find nothing worth remarking upon in the other sections of 
"The Obstetric Properties of the Pelvis;" though the young practi- 
tioner may find some good practical remarks under the head of de- 
formity of the pelvis; and some important cautions will suggest them- 
selves in reading the case of the lady, who had several children de- 
stroyed by the perforator, and who was several times after, delivered 
without extrinsic aid, of living children. 

Chapter II. is occupied by the description of the child's head; both 
in its natural dimensions, and where it is beyond the standard mea- 
surements. As there is nothing new in this chapter, we shall not at- 
tempt to analyze it. 

Part II. comprises menstruation; the description of the gravid ute- 
rus, with the doctrines of conception, sterility, and the signs and dis- 
eases of pregnancy. 

In treating of menstruation, he refers the reader to works of ana- 
tomy for the organ that produces it. He says, "we do not pretend 
to throw any new light on the causes of this periodical discharge." 
He looks upon the menstrual fluid as differing from the common 
blood in several particulars, as in colour, chemical analysis, constant 
fluidity, and its power of resisting putrefaction. He says, " the cata- 
menia are invariably suppressed in pregnancy;" this is by far, too 
sweeping a declaration, if our experience avail us any thing. 

When there is an entire failure in the appearance of the catamenia, 



148 Ashwell's Treatise on Parturition, fyc. 

"nature," Mr. A. says, "almost invariably attempts to remedy the 
misfortune by setting up some other evacuation, which in a measure 
supplies the place of the proper one, as far as concerns their health. 
In some we find a periodical discharge from the nose, from the anus, 
from the puncta lachrymalia, from the ears or the nipples; and Bau- 
delocque knew a woman of seven or eight-and-forty, who from the 
age of fifteen, had been regularly attacked every month by a vomit- 
ing and purging, which lasted three or four days. She never had the 
catamenia," p. 96. Cases of the entire want of the catamenia are cer- 
tainly very rare — we have known but two instances; but in neither of 
these, did any compensating discharge take place, nor can we see 
the necessity in such instances; as in some, certainly, and in all, most 
probably, there existed defective organization; either the uterus or 
ovaries were wanting, or they were deficient in structure, or in 
development at least. Here there could be no necessity for the cata- 
menial discharge, as the animal was not to profit by it; and it cannot 
be a sine qua non to health, since in both the instances just mention- 
ed, the females enjoyed a very fair proportion of it. Not so, how- 
ever, we are taught to believe, when this discharge has been acci- 
dentally interrupted; in such cases we hear of vicarious functions be- 
ing instituted, though we have never in a single instance witnessed 
such a transfer of action. Nor is there any thing more remarkable in 
the case quoted from Baudelocque, than in the periodical appearance 
of hsemorrhoides in men; coincidence we believe must account for that 
phenomenon in Baudelocque's patient. 

On the derangements of the catamenia, we find nothing novel or in- 
teresting. 

Chapter II. is bestowed upon the " Gravid Uterus, with the doc- 
trines of Conception, Sterility, and the Signs and Diseases of Preg- 
nancy." On the subject of the condition of the uterine parietes dur- 
ing gestation, he does not appear to have made up his mind distinctly 
whether they become thicker or thinner; at least he says, " we are 
not aware of any facts which enable us to speak with absolute cer- 
tainty on this point, as there are in the obstetric museum at Guy's 
Hospital, four preparations of the pregnant womb which demonstrate 
its thickness and thinness in an extraordinary degree." We are not 
informed of the circumstances connected with these "preparations," 
and which would be absolutely necessary, were conclusions to be 
drawn from them, as the four may have been in morbid conditions. 
The unusual thickness on the one hand might be owing to serous de- 
positions from previous inflammation; while on the other, the extreme 
thinness may have been caused by an excessive flooding — in neither 



Ashwell's Treatise on Parturition, fyc. 149 

case, therefore, could they be adduced as instances of the ordinary, 
or healthy (economy of the uterus. 

Mr. A. however, with the intention of proving, that in certain 
cases this great tenuity of the uterine parietes takes place, says that — 

" A professional friend mentioned to me the following singular and interesting 
case: — A lady of delicate fibre who had borne several children, slipped off the 
pavement, but did not fall, in the last month of pregnancy. Acute pain was im- 
mediately felt in the uterine region, and when examined by a very experienced 
surgeon, so plainly were all the parts of the foetus felt through the abdominal 
coverings that he did not hesitate to believe that the uterus was lacerated, and 
that the child had escaped into the abdominal cavity. In a few days, however, 
she was safely delivered " per vias naturales," of a healthy child, thus plainly 
showing, in this instance, the extreme tenuity of the uterine parietes." 

We have seen in very delicate and emaciated women, the same 
kind of "tenuity" spoken of by Mr. A. that is, where almost the 
whole form of the foetus could be traced, and portions of the limbs 
occasionally so prominent as to almost excite the belief, that they 
might be seized through the abdominal and uterine parietes. In these 
cases, however, there was but a moderate distention of the uterus, 
and no great abundance of liquor amnii. Yet all this does not prove a 
preternatural " tenuity" of the uterus; for so long as gestation ad- 
vances healthily; that is, so long as the fcetus is regularly developed 
and nourished, the uterus must have its proper quantum of blood; and 
if this be so, its parietes will necessarily be of proportionate thick- 
ness; a circumstance of considerable consequence to its future action. 
This is abundantly proved by the loss of power the uterus sustains, 
when it is deprived of much blood, as in flooding cases. We see 
nothing more in this chapter to challenge our attention, or to elicit 
farther remark. 

Chapter III. (by mistake called Chapter II.) treats of "Con- 
ception and Sterility." The author dismisses these subjects very 
soon; the former he treats with great brevity considering the strong 
temptations it holds out for ingenious, but perhaps unprofitable, spe- 
culation; on the latter he bestows but a few lines, notwithstanding 
its great importance in a pathological point of view. He makes ste- 
rility depend upon four principal causes; namely, 1, too early mar- 
riage; 2, ill health; 3, too frequent sexual intercourse; and 4, dys- 
menorrhea. 

The first of these causes does not appear to operate in this country 
to the end supposed. The second, unless the uterine system is im- 
plicated, rarely prevents conception. The third is an extremely 



150 Ash well's Treatise on Parturition, fyc. 

doubtful cause, since it would be difficult to define what degree of 
frequency of sexual intercourse, would constitute the cause of failure. 
" The effect of frequent intercourse in inducing sterility," Mr. A. 
says, "is obvious from the case of prostitutes, in whom it is said, the 
fallopian tubes contract adhesions with the contiguous parts of the 
peritoneum." 

To us, this cause is very far from being obvious; first, because all 
are not barren. Second, because they escape labours by procuring 
abortion. Third, because the greater part are particular to wash the 
parts after intercourse, which may aid in the immunity from concep- 
tion. Fourth, because it remains to be proved, that the fallopian 
tubes more frequently contract adhesions in wantons, than in modest 
women — that it has been more frequently observed in them, is every 
way probable; because they become very much more frequently the 
subjects of observation. Fifth, because these adhesions would not 
necessarily be fatal to conception, unless both tubes were thus cir- 
cumstanced. 

Chapter IV. is devoted to the " Signs and Diseases of Pregnancy." 
In this chapter the author successively treats of the affections incident 
to impregnation; or what Baudelocque calls the rational signs of preg- 
nancy. But we find nothing to arrest us here. 

Part III. is devoted to " Labour in all its Varieties. " He divides 
labours into three classes. Class I. Natural labour. Class II. Diffi- 
cult labour. Class III. Flooding labour. 

" Annexing", as exceptions to natural labour, those complicated and anomalous 
circumstances which have generally constituted a distinct class." p. 220. 

We are by no means certain that we comprehend the above sen- 
tence, we shall therefore pass it without remark. 

" Class I. — Natural labour, may be denned, that which is occurring at the full 
time, the head of the child presenting, and the process being completed within 
twenty- four, or twelve, or frequently within six hours, without artificial aid, or 
the occurrence of any morbid affection. This comprises three orders." 

"Order 1. Quick labours, occurring by far the most frequently, in which the 
process is easily completed within the prescribed time." 

"Order 2. Lingering labour, the head of the child still presenting, but con- 
tinuing beyond twenty -four hours, instrumental aid not being required." 

"Order 3. Twin labour." 

" Class II. — Difficult labour, or those in which the child may or may not pre- 
sent the head, and where the natural powers are generally insufficient to ac- 
complish the delivery. This comprises three orders." 

" Order 1. Presentation of the breech, of the superior or inferior extremities, 
or any combinations of these presentations, and which require manual sad" 



Ash well's Treatise on Parturition, 8?c. 151 

"Order 2. Labours which cannot be completed without the aid of extracting 
instruments, of which some are designed to save the lives of both mother and 
child; while others are intended to preserve the life of the mother, at the expense 
of the life of the child." 

"Order 3. Impracticable labour, or that in which the child, even when as 
much as possible reduced in size, cannot pass through the pelvis, and where 
the Caesarian operation becomes necessary." 

" Class III. — Flooding labour, including the earlier and later haemorrhages at- 
tendant on gestation as well as parturition." 

We have given Mr. A. 's classification entire, which it will be per- 
ceived, differs but little from the classifications of almost all the British 
writers, and consequently liable to the same general objections; name- 
ly, too much complication, in its general and detailed structure, and 
making portions of time essential to particular classes of the division. 
But every gentleman is entitled to his own notions upon this point; 
and perhaps no very serious injury will result, so long as his defi- 
nitions are clear, and his exceptions well marked and accurately 
limited. 

We very much prefer the classification of Baudelocque; it is much 
more natural as well as more perspicuous, as it embraces every pos- 
sible variety of labour, without the risk of either the cases or orders 
being confounded. Besides it is much more easily understood by 
beginners, and is much less embarrassing to young practitioners. The 
propriety of making the presentation of the head essential to a natu- 
ral labour, is very questionable; as its practical tendency may be 
highly injurious; for this part has its good, and its bad positions. But 
with the ill instructed practitioner all are alike, and the case is per- 
mitted to proceed even to the exhaustion of the woman and the death 
of the child, because it is a " natural labour," agreeably to definition. 
Thus, it is the head which presents, in that very embarrassing case, 
where the chin leaves the breast in the beginning of labour, and would 
constitute from the head presenting, a natural labour, and more espe- 
cially, if the woman can deliver herself within twenty -four hours, 
though this may be at the expense of the child's life. In this case, 
the judicious interference of the accoucheur may save many hours of 
severe suffering to the woman, and preserve the life of the child; but 
this interference would immediately confound the classes of labour, 
which would be a high crime and misdemeanor; since we are direct- 
ed to do nothing in a " natural labour." The face is also a portion 
of the head; and the woman may struggle through the difficulties 
created by its particular position within twenty-four hours if left to 
herself; though it might be highly advantageous, and certainly agree- 
able to the best rules of practice, if a matured judgment decide, that 



152 Ash well's Treatise on Parturition) fyc. 

the woman shall not be subjected to such severe penalties, for the 
sake of definition. 
Indeed the author himself seems to concede this point, when he 

says — 

"It is of extreme importance that the mechanism of natural labour, or rather 
the precise course taken by the child's head in passing through the bony canal of 
the pelvis should be well understood; as it will be vain to expect the efficient 
management of a bad presentation of the head, when its simplest and most na- 
tural mode of transition is imperfectly known." And very judiciously adds, 
"We are well aware, that many practitioners deem this knowledge superfluous, 
as if the head do present, they trust implicitly to the natural powers for its de- 
livery, thus not unfrequently condemning their patients to hours of suffering, 
which a slight acquaintance with the principles on which natural parturition is 
conducted, would have been amply sufficient to prevent." p. 236. 

We are persuaded that much practical advantage is derived from 
the classification of Baudelocque, since it is altogether conformable 
to truth; that in all labours where the woman can deliver herself, as 
when the head, breech, feet, or knees present, are natural. And 
when she is not able to do so, that they are then preternatural; for 
either of these presentations may be essentially, or accidentally bad, 
and require assistance; for the particular presentation of the part itself 
may from mere peculiarity of position, require to be interfered with, 
as, for instance, the third and sixth of this author's head presenta- 
tions; and the fourth of either of the breech, feet, or knees. Besides, 
the young practitioner finds much comfort, when he encounters a pre- 
sentation of either the breech, feet, or knees, after he has been taught 
that these are ranged under the head of natural labours; and is thus 
prevented from unnecessary, if not from dangerous interference, to 
which he would be tempted, if he had been taught they were preter- 
natural. 

Mr. A. ? s first order of Class II. appears to us to be particularly 
exceptionable; it confounds the presentations of the breech, feet, and 
hands, notwithstanding the essential differences of the mechanisms of 
labour, of the superior and inferior extremities; and as he directly as- 
serts, that they all require " manual aid. " Now it is a fact every way 
notorious, that the labours in which the breech and feet present, will 
sometimes be terminated with as much speed as success by the un- 
aided efforts of the uterus, while those in which an arm may offer 
never terminates spontaneously; unless, indeed, it be insisted, that 
the tardy and uncertain movement called " spontaneous evolution," 
is an exception. 

We are a little at a loss to comprehend the following sentence, 



AshwelPs Treatise on Parturition, fyc. 153 

though from the manner in which it is introduced, it seemed to be 
considered of consequence by the author. " It is a rule in midwifery 
to see a patient about to be confined, as early as possible; for there 
may be a preternatural presentation; and from the rupture of the 
membranes and the escape of the waters, the favourable moment for 
turning may be lost, previously to the arrival of the accoucheur," p. 
229. Does Mr. A. mean that the membranes must necessarily be 
ruptured before the patient is seen by the accoucheur? This cannot 
be, yet what other construction can be given to it. 

The author proceeds to make a number of practical, but well-known 
remarks upon " the changes immediately previous to parturition, de- 
livery," &c. but as nothing new or striking present themselves, we 
shall pass by them, until we come to his description of the mechan- 
ism of a natural labour. 

He illustrates "the most common presentation" by Plate I. to 
which he refers. This plate is extremely faulty, and were a young 
practitioner to form his opinion of the situation of the head at the supe- 
rior strait from it, he would be very much deceived. The following 
are the faults we perceive in this representation. First, The angle of 
the opening at the superior strait is much too great Second, The 
head does not enter in the direction of this angle, for the centre of 
the head corresponds with the superior margin of the symphysis 
pubis; the body of the child is completely vertical, and instead of the 
head being engaged in the upper strait obliquely forward, it is made 
to rest obliquely backward. Third, In this presentation of the head, 
(the first of Baudelocque,) the right parietal bone should be deeper 
in the pelvis than the left, but the contrary is represented by the 
plate. Fourth, The left ear is more within reach than the right; 
the reverse of this should be the case. The second plate is faulty, 
inasmuch as it should have represented the same presentation in pro- 
gress; whereas it is an advanced stage of the second presentation; 
the third plate is good. 

We cannot agree with the author in the following declaration:— 
" Cramps, which are occasionally arising from pressure on the obtu- 
rator and sciatic nerves are favourable, inasmuch as they indicate the 
rapid descent of the child through the pelvis. " p. 249. The contrary 
of this is most consonant to our observation, and also to truth, and for 
this plain reason, that in the more rapid labours, there is less friction 
between the head of the child and the lining of the pelvis; and con- 
sequently, the head is less liable to impinge upon the sacral nerves, 
than if it occupied the pelvic space with entire strictness. For these 
cramps do not take place until the face, or hind head, is about to 

No. VII.— May, 1829. 20 



154 Ash well's Treatise on Parturition, tyc. 

sweep into the hollow of the sacrum, and they are never so bad as 
when the head finds some difficult y from want of room in making this 
turn. 

Mr. A. says, " a diversity of practice has obtained in the manage- 
ment of the membranes; some practitioners invariably leaving their 
rupture to the natural efforts, while others as invariably break them 
by artificial means, so soon as they are within reach, and before the 
dilatation of the os uteri is fully accomplished. Of the latter practice 
we do not approve; the rule should be, to leave their rupture to the 
natural efforts." We cannot but severely condemn the first plan, as 
it may very often occasion both delay and difficulty; nor can we ap- 
prove of the author's regulation upon this point, as we are certain 
when it is strictly followed, it occasions much unprofitable delay, as 
well as creates a risk of subsequent evils — flooding, and retention of 
the placenta. Our habit for very many years is, to rupture the mem- 
branes whenever the os uteri is sufficiently dilated or easily dilatable; 
nor have we ever had reason to repent of this practice. By it, we 
are almost certain to procure more powerful contractions of the ute- 
rus, and prevent delay in the throwing off* of the placenta. On the 
whole, the subject of natural labour is treated with judicious care. 

" Order 2. Lingering labours; the head of the child presenting, 
but continuing beyond twenty-four hours, instrumental aid not being 
required." It is truly difficult to account for the lapse of twenty- 
four hours, being a period by which the character of a labour is to be 
distinguished; hours should never alone govern our conduct, as to the 
choice of means to terminate a labour. We have very often seen a 
necessity for manual, or even instrumental interference necessary, 
very much within the period of twenty-four hours; and much oftener 
have we witnessed cases terminate happily without extrinsic aid, that 
were protracted very much beyond the period of twenty-four hours. 
In midwifery, time should never be the guide; it is no principle in 
itself, nor can it possibly create one by which we should be governed; 
circumstances alone should regulate our conduct; and if these be well 
understood, and carefully weighed, we shall rarely err. 

Had our author entertained similar sentiments, he would not, we 
think, have managed the following case as he declares he did. 

"I was lately called to a case, and requested by the accoucheur to use in- 
struments, where the patient had been in labour forty-eight hours with her first 
child; the parts had been rig-id, and sixteen ounces of blood had been early 
abstracted; the head had been for many hours resting on the perinasum, and the 
pains were ineffective and at distant intervals. I encouraged the patient to hope 
for a safe delivery, ordered some solid nourishment and port wine negus; and 






Ash well's Treatise on Parturition, 8?c. 155 

in three hours the labour was safely completed, although the child was dead." 
p. 267. 

We have italicised a part of this history, and we would ask why 
the forceps were not used as recommended by his more judicious 
companion under the circumstances thus marked ! And we would 
farther demand, what other than a dead child could he promise him- 
self after it had been so unnecessarily long delayed in the passage ? 
This case illustrates any thing but sound practice. 

Our author's remarks upon the use and powers of the ergot, are but 
mere reiterations; and his condemnation of blood-letting in cases of 
rigidity of the soft parts, are entitled to no weight, as he never ap- 
pears to have adopted it, either to the extent, or under the circum- 
stances for which it has been recommended. He says, " we cannot 
perceive that Dr. Dewees has thrown any new light upon the sub- 
ject; he has certainly recommended larger abstractions of blood, (a 
practice previously enjoined by Mauriceau to a moderate extent,) 
than we should feel disposed to adopt, unless the rigidity was ex- 
treme, the pulse very full and frequent, and the general tendency to 
inflammation and fever marked and decided. " 

The whole of this passage is remarkable for its incongruity and dis- 
crepancy. First. The author would insinuate, that extensive blood- 
letting had long since been recommended by Mauriceau, in cases of 
unusual rigidity; yet he instantly destroys his own assertion by de- 
claring, that it was "to a moderate extent." Now, a large bleed- 
ing, and a small bleeding, are two distinct remedies in the cases un- 
der consideration; for the latter exerts no appreciable influence upon 
the parts intended to be relieved by it; while the former is certain, 
to produce the relaxation, so much desired. 

Second. He confesses he would employ this remedy in cases where 
the " rigidity was extreme, the pulse very full," &c. now, is this not 
the very case, and conditions, for which a bold use of the lancet is 
recommended by Dr. Dewees? In what then does Mr. A. and Dr. 
D. differ? Certainly in nothing; for he adds immediately after, "we 
trust we should never hesitate to adopt the boldest and most vigor- 
ous treatment, when absolutely required." Dr. D. never does more, 
nor even that, but when it is " absolutely required." His fears for 
the patient after the loss of "thirty, forty, or even fifty ounces" of 
blood, are entirely groundless; for we have many times drawn that 
quantity under the circumstances just stated, and we can most con- 
scientiously declare, we have never witnessed the smallest evil result 
from it. 



156 Ash well's Treatise on Parturition, fyc. 

The section of " Twin Labour" contains nothing that need detain 
ns a moment. On the subject of " Complications of Natural Labour," 
our author seems to think he has improved the classification of la- 
bours by uniting the accidents incident to parturition, with the con- 
sideration of natural labour. He says— 

" We are aware, that in associating- these anomalous and complicated events 
with natural labour, we deviate from the course generally pursued, a distinct 
class having- been assigned them. This arrangement, however, appears capable 
of improvement; for as all these occurrences may happen where the presenta- 
tion is natural, it is certainly more simple, and perhaps more correct, to subjoin 
them to this order of parturition." p. 285. 

He divides these affections into two classes:— 

" First. Those which are remediable by proper treatment, and which less 
seriously involves the safety of the patient and her offspring; and, second, 
those which from the moment of their appearance are replete with danger, and 
which, notwithstanding the most able treatment, compromises the safety of both 
the mother and the child. In the first class we comprise obesity; syncope, not 
dependent on haemorrhage from the uterus; rigors, vomiting, and fever. Haemor- 
rhage from any part except the uterus; obliquities of the uterus; distended or 
prolapsed state of the bladder. Prolapsus ani; oedema of the cervix of the ute- 
rus, and sanguineous or lymphatic infiltration of the external parts; malposition 
of the head; the descent of the funis, or the hand with the head. In the second 
class we enumerate, laceration of the uterus and vagina; laceration of the blad- 
der; tumours in the pelvis; convulsions." p. 287. 

Mr. Ashwell need have only consulted Baudelocque, or any of the 
French writers since his time, to have discovered the very association 
he has made, and which he seems to insinuate, is original with him. 
As respects ourselves, we entirely agree in the propriety of this ar- 
rangement; for we have been familiar with it ever since we read 
Baudelocque, and constantly acted agreeably to the indications they 
have severally afforded. It appears to us a little singular that " obe- 
sity" should be enumerated as one of the " accidents" accompanying 
a natural labour, any more than any other labour that may happen. 
It is a constitutional defect; but it never occurs suddenly during par- 
turition. Therefore the observations on labours of very lusty women, 
properly belong to the considerations of labours in general, and should 
have been placed there. Fatness alone, does not necessarily create 
difficulty; we are in the habit now of attending several very fat wo- 
men, and have attended many such since we have commenced busi- 
ness; but in no instance did this condition of body of itself create dif- 
ficulty. It is true, we have in two instances encountered severe and 
tedious labours; but in both of these cases the pelvis was contracted; 



Ashwell's Treatise on Parturition, fyc. 157 

in the majority of other cases the process was such as ordinarily oc- 
curs; in several, the labours were as rapid as in leaner women. 

" Syncope, not dependent on haemorrhage from the uterus," is not 
a frequent occurrence, nor is it alarming, when it depends upon some 
peculiarity of the nervous system. It is, however, occasionally very 
distressing, and requiring the immediate interference of the accou- 
cheur. Of this kind are the cases related by Baudelocque, as pro- 
ceeding from a gall-stone; and the one given by Dr. Davis, and for 
which no cause could be assigned. The one recorded by our author, 
we are of opinion was nothing more than the after-effect of the large 
doses of laudanum he administered during the progress of the labour, 
for half an ounce of this medicine was given in one hour, in enemata 
— we have several times seen long-continued syncopes from the use 
of opium. 

Be this as it may, Mr. A. in managing this case did not act upon 
the principle he lays down for the treatment of syncope, when not 
occasioned by uterine haemorrhage. For he says, that " the forceps 
and the ergot appear to afford the best chance of relief in these 
cases," yet he employed neither, in the case he has recorded — on the 
contrary, he permitted the labour to take its course, notwithstanding 
the uterus was " fully dilated" a long time before it terminated, 
though he says, " at one period I had prepared some infusion of the 
ergot, and should have used it had not the pains recurred." 

It may be said, however, in this case, that Mr. A. pursued the 
proper course, as the labour terminated without the aid of either er- 
got or the forceps — we will only answer, it so happened; but had 
Mr. A. any security that this would take place without some extrin- 
sic aid? 

In his account of the bad position of the head, he includes the presen- 
tations of the face; the whole of this section seems to betray either a 
deficiency of experience, or a want of careful observation. His opinions 
on the face presentations, are at variance, so far as we know, with all the 
best writers upon midwifery. He has followed the arrangement of Bau- 
delocque; but he has not profited by this enlightened practitioner's opi- 
nions upon the comparative safety of the respective presentations; for 
he insists, that " where the chin of the child is opposed to the pubes, 
is the most favourable position, both as regards the safety of the child 
and the facility of management." p. 309. We might oppose our own 
experience to this declaration; but we will do better; we will give^the 
opinions of Baudelocque and Burns upon this point. The presenta- 
tion under consideration, is the second face presentation of the first 
of these authors; of this he says, « we cannot expect to reduce the 



158 Ash well's Treatise on Parturition, fyc. 

head to a natural position, in the second presentation;* it would be 
wrong and dangerous to attempt it, but when the membranes have 
just opened." We cannot indicate with certainty the precise po- 
sition of this species of presentation, in the work of Mr. Burns, as 
he expresses himself with very little precision on this point — there- 
fore, lest we should commit ourselves in giving it a numerical loca- 
tion, we will quote the whole of the sentence that refers to the sub- 
ject in question. 

" The face may present with the chin to one of the acetabula, or 
to the sacro-iliac junction, or to the pubis, or to the sacrum. The 
first two are the best, the second is more troublesome, and the last is 
worst of all." Now if this statement be correct, there will be six 
presentations of the face; for if the chin can offer, either to an aceta- 
bulum or to a sacro-iliac junction on one side of the pelvis, it may be 
able to do so on both. But no matter; the chin he says may present 
to the pubis, and this " is more troublesome" than the two first. 
From this it is evident, that neither of these gentlemen regarded the 
presentation under consideration, " as the most favourable, both as 
regards the safety of the child and the facility of management." We 
may go further; we may even question the possibility of this position, 
and its reverse; and we think it would be no very difficult matter to 
prove this, were this the time or place. 

For the relief of this case, our author says turning may be attempt- 
ed, when "the pains are not very severe, and if the head has scarcely 
descended at all beyond the brim, the os uteri being well dilated." 
He adds, "we prefer, however, if possible, to rectify the position, 
and by disengaging the forehead and chin, convert it into a vertex 
presentation." Convert a face presentation into a vertex by " dis- 
engaging the forehead and chin. " ! ! For there is not a mention made, 
of placing, or restoring the chin of the child to its breast, and with- 
out which, he could not convert a face into a vertex presentation. 

'* The instrumental management of these cases comprises the use both of the 
lever and forceps. If the presentation be early discovered, the lever may, perhaps, 
by judicious and skilful application, effect an alteration of position, more ad- 
vantageously than the hand alone. To accomplish this purpose, it must be in- 
troduced by the side of the pelvis, and passing over the vertex, it must obtain 
a firm bearing on this part. We may afterwards depress the occiput, carefully 
raising up the face, by the fingers of the other hand." 

Now we do declare, and this without the fear of contradiction, that 

* "In the second position, the length of the face presents parallel to the small 
diameter of the entrance of the pelvis; but the chin is behind the pubes, and 
the forehead before the sacrum."— Bauddocque. 



Ashwell's Treatise on Parturition, fyc. 159 

the operation now described never has, nor never can be performed; 
and for this plain reason — because it is impossible. No skill, no ad- 
dress, can place the clam of a lever upon the vertex, when the face 
is situated as just described; for it is mounted above the pubes, and 
even a little in advance of the symphysis; and consequently, would 
require that the handle of the vectis be carried farther backwards 
than even the point of the coccyx, (were this practicable,) before it 
could command the advanced vertex. Besides, in this case, the lever 
would not be long enough, as it is generally made, by several 
inches, were no other difficulty to present itself— it cannot be done, 
even upon the machine. 

It is true, that our author may say, that the plan in question 
has been recommended by Baudelocque, who may be looked upon 
as paramount authority — but it is proper that we should not be misled 
even by Baudelocque, when reason and fact oppose his doctrine. For 
it has been attempted over and over again upon the manaquin, and 
the impossibility to perform, what has here been recommended, has 
been most successfully demonstrated. Now, if our datum be true, as 
we most honestly believe it is, Mr. A. cannot have written from his 
own experience; and he may verify for himself, what is here assert- 
ed, should this ever meet his eye, by repeating the experiment, of 
reducing the vertex by means of the lever, when the face presents in 
the situation in question. 

We have dwelt longer upon this point than we intended; but its im- 
portance must plead our excuse; for in difficult cases, too much care 
cannot be exercised, that the young practitioner may not be mislead; 
for upon proper directions the lives of both mother and child may 
depend. 

One of Mr. A.'s rules for the management of footling cases is very 
singular; and we are disposed to believe that the advice as it stands, 
to be a slip of the pen, rather than a deliberate direction to be lite- 
rally followed. He says, "The rule, therefore, is, not to interfere 
until the nates are born; not to rupture the membranes. " Has Mr. 
A. ever seen a case at full time, in which the membranes were pre- 
served until the nates were without! And we do not hesitate to say, 
that another which quickly follows, would as often destroy the child 
as it would preserve it: — 

"In presentations of the breech and feet, this turn," (the great diameter of 
the head being placed to that of the strait,) "is equally desirable; and if, when 
the nates have reached the external parts, we find the toes pointing towards 
the symphysis pubis, we know the head is unfavourably situated. Grasping the 
parts firmly, therefore, having previously covered them with a napkin, we wait 



160 Ash well's Treatise on Parturition, fyc. 

for the next pain, and then such an inclination is to be given to the body of the 
child, as shall direct its abdomen towards its mother's spine." p. 350. 

We look upon these directions to be wrong, from the beginning to 
the end, if the evil they are intended to remove, were absolutely cer- 
tain of accomplishment. Because, first, it directs that the turn with 
a view to correct the position of the head, is not to be made until the 
nates are without; now we have no hesitation to say, if left until this 
period, it would either be unavailing, or injurious; unavailing, be- 
cause, no movement that can be executed upon the body of the child, 
would have sufficient influence on the head, to make it change its po- 
sition, for it would do no more than give a twist to the neck;. injuri- 
ous, because this very twist, would describe half a circle; one-quar- 
ter too much for the safety of the child. If this change becomes ne- 
cessary from the presentation of the child, namely, as in the fourth 
of Baudelocque,* it should be attempted during the whole progress 
of the legs through the os externum; and even then its success would 
be extremely doubtful, owing to the head not obeying a twist given 
by the neck, however extensive this may be. But this twist should 
never exceed a quarter of a circle. 

Second. He directs that this twist should have the co-operation of 
a pain — the very worst time to make the attempt; for during a pain, 
the head will be firmly embraced by the contracting uterus, and con- 
sequently cannot obey an impulse given to it by twisting the body of 
the child, if it should be even made to feel one by the manoeuvre recom- 
mended by Mr. A. when not opposed by the contraction of the uterus. 

Third. If it were granted, that the position of the head can be 
changed by a movement executed upon the body of the child, it might 
be fatal to it, as the chances are equal, that this twist may be given 
in a wrong direction. 

There is room for remarks upon the want of precision in his di- 
rections for the delivery of the arms and head — but we must pass 
them by. 

" Class II. Order 2. — Labours which cannot be completed without the aid 
of extracting" instruments," &c. Sect. 2. 

Of the Forceps.— Mr. A. commences his remarks upon these in- 
struments with the following judicious and important remarks; and 
to which we most cordially subscribe: — 

*"The fourth presentation of feet, the child's back and heels are towards 
the posterior part of the uterus, while the toes, the face, and the breasts are 
under its anterior part." — Baudelocque. 



AshwelPs Treatise on Parturition, 8?c. 161 

« If after a fair trial of every expedient, which the peculiar circumstances of 
the case may suggest, and after having- allowed the fullest exertion of the na- 
tural powers compatible with the safety of the woman, the labour makes no ad- 
vance, we must have recourse to instrumental aid, and while it is peculiarly de- 
sirable that this should not be prematurely bestowed, it is not less so, that a 
timid dread of the use of instruments, should not deprive the woman of her only 
chance of escape, from the generally fatal consequences of a too protracted la- 
bour. We do not deny the danger arising from the forceps and lever in the 
hands of hasty and injudicious practitioners." p. 358. 

We cannot, however, approve of the practitioner waiting until alarm- 
ing, and above all, until dangerous symptoms shall make their appear- 
ance, before artificial means be resorted to; we cannot therefore alto- 
gether approve of the rules for the use of the forceps as laid down by 
our author. A necessity for employing artificial means will exist 
agreeably to him, when 

" The pains become weak, short, and inefficient, producing no effect on the 
head of the child; sometimes they are entirely suspended; and although their 
cessation within the first twenty -four hours does not justify the use of instru- 
ments, as it may be only temporary, yet if it occur at the end of the second or 
third day, if the pulse, the countenance, and the general appearance of the 
woman are expressive of extreme debility and fatigue, a strong presumption is 
afforded, that we have waited sufficiently long to unassisted nature. If, in ad- 
dition to these symptoms, we have head-ache, mental inquietude, shivering 
and vomiting, a pulse 120 or 130, furred tongue, a hot skin, great thirst, abdo- 
minal tenderness, heat and soreness in the vagina and os uteri, we feel assured 
our patient has approached to a state, from the evil consequences of which in- 
strumental aid will alone deliver her." p. 362. 

We believe that we do not assert too much when we say, that 
no well instructed American accoucheur w r ould wait until the above 
dangerous symptoms show themselves, before he would have recourse 
to efficient aid; and would feel it as bounden a duty by timely inter- 
ference to prevent such alarming symptoms from taking place, as our 
author appears to feel it to be his, not to give assistance until they 
have occurred. We would ask, for information, what prospect of a 
happy termination has that practitioner who only resolves to employ 
the sole means that can afford relief, after the direful symptoms last 
enumerated have taken place? — we say, we ask for information; for 
the American practitioner rarely has it in his power to witness such 
a case, or to become acquainted with its result. In his estimation, 
it would present nothing but hopelessness and destruction; he may 
be wrong, however, in his prognosis; but he could scarcely be per- 
suaded to put his judgment to the test, by permitting the case to run 
on, until such symptoms appear. Regulating the propriety of inter- 
No. VII.— Mav, 1829. 9A 



162 AshwelPs Treatise on Parturition, fyc. 

fering with a labour by the number of hours that may elapse, instead 
of being guided solely by symptoms on the part of the mother, and 
the preservation of its life on the part of the child, is the very bane 
of sound practice; but our pages warn us to stop, or we could say 
much upon this most interesting point 

Mr. Ashwell, like ourselves, is an advocate for the long forceps; 
and in the use of these instruments, has inculcated sentiments, in 
regard to this point, that we have often wished to establish. "We 
therefore transcribe with much pleasure his observations; and we do 
this the more willingly, as they come from a quarter from which op- 
position almost alone, has been made to the use of these instruments; 
namely, Great Britain. 

Mr. A. says, " There can be no doubt that many of the difficulties of partu- 
rition, for the removal of which the perforator has often been employed, were 
cases in which the head, owing- to the contraction of the brim, could not, by 
the unassisted efforts of the uterus, be propelled into the cavity of the pelvis. 
The practitioner in these circumstances, unacquainted with the value of the 
long forceps, would wait probably for some considerable time; but finding" that 
the head made no advace, perhaps that not one-third of its circumference was 
encircled by the brim, and knowing- that it was impossible to reach it by the 
common or short forceps, and that exhaustion and other dangers might be in- 
duced by farther delay, feels little or no hesitation in unnecessarily sacrificing 
the life of the child to the safety of the mother. All instruments may be ren- 
dered dangerous, if too early and rashly used; yet we think that experience is 
decidedly in favour of the greater safety of the mother, from their too early, 
than from their procrastinated employment. Rupture of the uterus, abdominal 
and local inflammation, terminating in gangrene and sloughing, irreparable ex- 
haustion of the system, and a series of other events not necessary to be enume- 
rated here, may all be occasioned by a too protracted difficult labour. Indeed, 
we are sometimes almost induced to believe, that great evil has arisen from the 
multiplied and fearful associations which have been so invariably connected 
with the use of instruments. Some practitioners are thereby deterred from even 
thinking of their employment, till a period has approached when little good 
can be anticipated from their aid. Others think it so superlatively difficult to 
determine the cases proper for their use, and the precise time and manner of 
their application, that they think it unnecessary to acquire a thorough know- 
ledge of the principles on which instrumental labour can alone successfully 
proceed, not remembering in some instances, valuable lives maybe entirely de- 
pendent on their sole and unaided exertions, and that before they can obtain 
the assistance of another practitioner, their secret source of reliance, the proper 
moment for interference may have been finally lost." pp. 368-9. 

In this general estimate of the value of the forceps; the advantages 
of the long, over the short; the dangers arising from too long delay, 
and the want of decision on the part of the practitioner, who may not 
be fully instructed in the more important principles of midwifery, as 



AshwelPs Treatise on Parturition, fyc. 163 

we have before said, we most fully concur; for they are points we 
have often and earnestly endeavoured to enforce, though we may de- 
spair of ever producing entire conviction on the minds of such as are 
predetermined, from either education, constitutional timidity, con- 
fined instruction, or more limited experience, against the use of these 
instruments. 

But let us not be understood as concurring in all the sentiments of 
our author on the use of the forceps, while the head of the child is 
still at the brim of the superior strait; for we are decidedly of opinion 
that much difficulty attends their use at this part of the pelvis. Indeed 
we think that none should undertake this operation but those who 
have become familiar with the application of these instruments at the 
lower portions of the pelvic cavity, and who are also thoroughly ac- 
quainted with the mechanisms of head presentations. 

For it is not alone sufficient as our author declares, to " let it be 
understood, that although very rarely, that sometimes artificial aid is 
necessary — that it behooves the practitioner accurately to discover the 
nature of the difficulty opposing delivery, and how far it is likely to 
be overcome by the natural efforts; that if he deliberately determines 
these to be insufficient, he is next to ascertain the precise situation 
of the child's head, in reference to the pelvis." For after these 
difficulties are overcome, others of greater magnitude will remain to 
be surmounted; namely, the adjusting of the instruments comme il 
faut, upon the child's head; overcoming. the resistance to its descent, 
and the proper navigation of it through the different straits. Nor can 
we agree that the knowledge by which all this is to be effected, can 
be either "clearly," or "simply taught"— for nothing short of con- 
siderable experience will ensure success, after the operator has been 
as "clearly and simply taught," the mode of applying the forceps 
when the head is at the superior strait, as the thing is susceptible of, 
without the aid of practice. 

We are of opinion, that the author has not been sufficiently explicit 
on the subject of the deviations of diameter at the superior strait, for 
all the purposes of practical utility. For it is not enough for the ill in- 
structed, who may seek for information in his book upon this head to 
be informed, that, "the long forceps is peculiarly applicable to those 
deformities of the brim of the pelvis, which are produced by contrac- 
tion of its antero-posterior diameter." p. 371. 

It would have been useful indeed, had he specified in explicit 
terms, the degree of contraction that precludes the use of the forceps 
altogether, or the extent, that can be surmounted by their aid; for 
almost every thing will depend upon the degree of opening in the an- 



164 Ashwell's Treatise on Parturition, fyc. 

tero-posterior diameter of the superior strait. For if this diameter 
be contracted below three inches, these instruments must not be 
thought of. 

He very properly and decidedly prefers the forceps in these cases, 
to the lever; for he very justly observes, that 

" The lever, unlike the forceps, has no fixed fulcrum, and if the first degrees 
of force are not sufficient to overcome the obstacles, an additional degree of 
power, injudiciously imparted, may, by converting the bony pelvis into a fixed 
point of action, seriously injure the soft parts of the mother." p. 372. 

We regret that one so apparently well acquainted with the power 
and utility of the long forceps, should so entirely have committed 
himself, by an indifference, whether these forceps have or have not 
a. i6 curvature." He says, "Some practitioners prefer this instru- 
ment with a curvature, by which the handles are thrown forward, and 
the perinaeum rendered perhaps more secure. We do not think this 
a matter of importance, as, after all, the protection of the perinaeum 
will mainly depend on the address and gentleness of the accoucheur." 
p. 373. 

But the security of the perinseum is not the point in question; for 
were it reduced to this, its security might be trusted, though with some 
risk, to " the address and gentleness of the accoucheur." Much more 
important considerations present themselves when an accoucheur at- 
tempts to deliver from the superior strait; namely, 1st, the difficulty 
of applying the instruments; and 2d, the mode of operating after they 
are fixed. In the first case, the axis of the superior strait is so much 
in advance of the inferior, that the forceps can only be made to tra- 
verse it by very strongly forcing the handles, of even the curved for- 
ceps, against the perinseum, and carrying it backwards. Now if this be 
the case with the curved instrument, as it certainly is, how much more 
necessary, and at how much greater risk of injuring the integrity of 
this part, must it be with the straight? Indeed we are of opinion, 
that this operation should never be attempted, but by the curved 
forceps. 

In the second place, it is absolutely essential to the success of this 
operation, that not only the axis of the superior strait be constantly 
kept in mind, but also that the oblique position which the head takes, 
(in consequence of the angle observed by it,) should be remembered, 
when it is about to enter and pass through this opening. For it must 
be recollected that the head does not, nor cannot offer perpendicularly 
at the upper strait, as the opening at this part is at an angle of from 
35° to 40°; consequently, the power applied to the head in order to 
make it descend, must be in the axis of this departure from a per- 



Ash well's Treatise on Parturition, 8?c. 165 

pendicular position; and to effect this, the handles of even the curv- 
ed forceps must be made to press forcibly against the perinaeum; and 
it would require that the point of the coccyx should be touched, if 
the straight forceps were employed, which would be very unsafe to 
the perinaeum, if it could even be preserved by any care or address of 
the operator. Indeed it seems but just to say that the author appears 
to be aware of the force which must be applied to the perinaeum, 
though he does not express it; for he says, (p. 365,) "If we are em- 
ploying the long forceps, and the head is above the brim we should 
draw down in a line towards the coccyx. " 

There is much obscurity in the following passage: — " When we 
can feel the ear in a vaginal examination, the case is manageable by 
the forceps;" (is it not manageable when we cannot feel an ear? Has 
not the author just spoken of delivery from the superior strait;) and 
the latter part of this period is altogether unintelligible; for continues 
Mr. A. "as the blades, being twice the length of the finger, will 
embrace the head, except where syncope is occurring from haemor- 
rhage, the ear may have remained in this situation some hours before 
the forceps is absolutely required." p. 365. 

Notwithstanding our conviction of the occasional necessity of the 
forceps, and our predilection in favour of the long ones, we cannot go 
the same length as our author, in recommending them; if we do, it is 
always under very severe restrictions, if the head has not passed 
through the superior strait. He says, " again, in those cases of haemor- 
rhage, syncope, or convulsions, arising when the head has not descend- 
ed sufficiently low into the pelvis, to be within reach of the common 
instrument, the advantages obtained, both for the mother and child, 
by the use of the long forceps, are very decided." p. 372. We 
would not wish the inexperienced practitioner to be so far misled by 
these observations, as to attempt the relief of his patient by using the 
forceps when the head is situated as just specified. Turning in such 
instances, under its proper restrictions, is the proper remedy, when 
the cases demand manual interference. Of the mode of applying the 
forceps; of the vectes; of the perforator; and the Caesarian operation, 
we shall say nothing; as we have already very far exceeded the limits 
we had prescribed to ourselves. And for the same reason, we shall 
pass in silence the whole of his third class, or flooding labours; as 
well as the fourth part of the work, comprising the diseases of the 
puerperal state, together with the appendix intending to notice 
these at some other time. 

W. P. D. 



( 166 ) 



BIBLIOGRAPHICAL NOTICES. 

XV. On Aneurism, and its Cure by a New Operation. Dedicated by permission 
to the King. By James Wabdrop, Surgeon to his Majesty. London, 1828, 
pp. 117, 8vo. 

The object of Mr. Wardrop in this publication is to prove the efficacy of 
treating" aneurism by fixing a ligature in certain cases on the artery affected, 
beyond the aneurism, or as it has been termed by British surgeons, on the distal 
side of the tumour. 

Though the experience presented by Mr. Wardrop is too limited to serve 
much further than as a guide to future inquiries, yet its character is so interest- 
ing that no apology is necessary for the following notice, which must be neces- 
sarily brief, as the work has but just reached this country, and the opportunity 
has not been afforded us of studying the cases detailed in it very closely. We 
shall, however, probably return to the subject hereafter. 

The fact is sufficiently familiar that as aneurism advances in age and in size, 
a concentric laminated deposition of coagulating lymph occurs in its cavity, and 
sometimes obstructs so completely the current of blood through it, that spon- 
taneous cures have taken place without the interposition of art. This tendency 
is so general and universal, that our distinguished collaborator, Dr. Physick, 
has proposed to make it a basis of cure in certain impracticable cases, by intro- 
ducing a fine metallic needle into the cavity of the aneurism, and leaving it 
there a sufficient time for a nucleus of coagulation to be formed upon it. It ap- 
pears also that this lymph is occasionally disposed to take on a condition of vital 
organism, like lymph effused into other cavities. 

With the fact before him of a spontaneous cure by a deposition of lymph 
filling up the sac completely, Brasdor, a professor of surgery in Paris, proposed, 
more than forty years ago, that in cases of aneurism, where the tumour was so 
near the heart or large cavities, as to make it impracticable to fix a ligature 
upon the cardiac section of the artery, the ligature should be fixed upon the 
remote or peripheral section of the artery, or the part beyond the tumour. The 
celebrated Desault was an advocate for this practice but never tried it. Des- 
champs, a contemporary, actually put it in practice upon the femoral artery, but 
from some peculiarly unpropitious circumstances the experiment failed. It was 
subsequently tried by Sir Astley Cooper, in a case of aneurism of the external 
iliac, but it also failed in his hands, the patient having died from the bursting 
of the aneurism. Notwithstanding the failure in these cases, the principle re- 
mained, that a perfect obstruction to the current of blood through an aneurism 
by a ligature beyond it, would cause the coagulation of the blood remaining in 
the tumour, and consequently a cure of the latter. 

Governed by these considerations, Mr. Wardrop, in June, 1825, on the per- 
son of a female, aged seventy -five, who had a carotid aneurism just above the 
right clavicle, took up the artery above the tumour. He has given a full account 
of the case and of the operation, but as the details are of a familiar kind, it is 



Bibliographical Notices. 167 

unnecessary to introduce them. On the fourth day the tumour had diminished 
one-third, on the fourteenth it was only half the original size, and at the end of 
the fifth week the neck had nearly resumed its natural form. At the expiration 
of three years the patient continued to enjoy good health. 

In December, 1825, a female, aged fifty-seven, was presented to him, with 
carotid aneurism of the right side, extending from the clavicle two inches up- 
wards. She was also operated upon by fixing a ligature on the artery above the 
tumour. This patient died on the 23d of March, from hypertrophy of the heart, 
the tumour having in the mean time subsided to the size of an almond, and the 
wound having cicatrized. On dissection the carotid artery was found empty, 
but dilated at the situation of the tumour, and the aorta and arteria innominata 
were unsound from ossific depositions upon their internal face. 

In January, 1 827, a female, aged forty-nine, of unhealthy appearance, having 
carotid aneurism also on the right side, above the clavicle, was submitted to the 
professional care of Mr. Wardrop, the tumour being the size of a large walnut. 
She was operated on by fixing a ligature on the artery above the tumour. The 
tumour after a while entirely disappeared and the wound cicatrized. Five 
weeks after the operation the cicatrix ulcerated and a fungous growth sprang 
up from it, this was followed by repeated haemorrhage, and the patient died 
about the sixtieth day from the operation. On dissection after death, the fol- 
lowing was found to be the state of the artery: — 

" At the root of the right common carotid artery was a consolidated tumour, 
of a pyramidal shape, its base below and extending two inches up the artery, 
and was at its lower part about half an inch in breadth. A probe could not be 
passed upwards, from the arteria innominata, and water forcibly injected at this 
part would not pass; so completely and effectually closed was the lower part of 
the carotid artery. On making a longitudinal section of the tumour, we ob- 
served at its lower part a firm coagulum of blood, of about the size of a French 
olive; it accurately closed the opening at the base of the carotid, and it was 
this which afforded the resistance to the probe and injection of water passing 
upward from the arteria innominata. The coats of the artery where surround- 
ing the coagulum, were thickened to about four times their natural size, and 
lined by a thin layer of fibrine. Above the coagulum the coats of the artery 
were thickened to the extent of at least six times their natural size, and in addi- 
tion to a layer of fibrine closely adherent to the inner surface of the artery, and 
continuous with that surrounding the coagulum at the lower part of the tumour, 
there were three other layers of coagulated lymph. They were evidently 
adapted to the cylindrical shape of the vessel, and appeared to have been 
formed successively, thus gradually encroaching upon and at length obliterat- 
ing the entire calibre of the artery. At the upper part of this thickened 
state of the artery, and just above the omo-hyoideus, where the ligature 
was applied, was an ulcerated opening on the anterior and tracheal surface 
of the carotid artery, a quarter of an inch in length and rather less in 
breadth, covered by a coagulum of dark-coloured lymph, communicating with 
the opening in the integuments. The posterior surface of the artery, corres- 
ponding with the ulcerated opening on the anterior part, was covered with a 
coagulum, and on removing this the division of the internal and middle coat 
produced by the ligature was observed. Above the ulcerated opening the ca- 



168 Bibliographical Notices. 

rotid artery was pervious and healthy, with the exception of a few spots, re- 
sembling those observed in the arteria innominata; and there did not appear to 
have been any attempt made to effect obliteration. The superior thyroidal 
artery, given off a little higher than usual, was readily distended by throwing 
water into the arch of the aorta, which passing through the left carotid artery, 
regurgitated by means of anastomosing branches, through the right external, 
internal, and common carotid artery, and flowed out at the wound. The trunk 
of the superior thyroideal became very manifestly enlarged on injecting the 
water from the aorta." 

In a fourth case of carotid aneurism treated by George Bush, M. D. Profes- 
sor of Anatomy, New York, the patient, a female aged thirty-six, and having 
a carotid aneurism, the size of a small hen's egg, on the right side, was operated 
on according to Mr. Wardrop's plan. The wound was healed on the twenty- 
seventh day, and the tumour was then reduced to one-half its bulk, and almost 
free from pulsation. On the 19th of the subsequent April, the patient was in 
perfect health with scarcely a remnant of the tumour. 

Encouraged by his instances of success, Mr. Wardrop undertook to cure an 
aneurism of the arteria innominata, by tying the subclavian artery. The case is 
that of Mrs. Denmark, aged forty-five, who had an aneurism the size of a 
turkey's egg, one portion of which was situated under the sternum, and the 
other appeared at the inner edge of the mastoid muscle. The subclavian artery 
was secured as it passed over the first rib by some peculiarities of minor account 
in the mode of operating. The operation having been executed on the 6th of 
July, the patient, about the end of August had got so far well that there was no 
appearance of aneurism left. The following report shows the state of the pa- 
tient one year afterwards, (August 8th, 1828.) 

" She is more reduced in point of flesh than at the period of the last report, 
but this has evidently been owing to the attack of bronchitis, and the severe 
measures to which she has been subjected, for, within the last six weeks, she 
has regained her former appearance in a wonderful manner. The difficulty of 
respiration has greatly diminished, so much so, that she can now sleep in the 
natural position, and she is entirely free from the dreadful sensation of threat- 
ened suffocation. No tumour is perceptible in the situation of the former aneu- 
rism, but an unnatural feeling of hardness can be perceived at the root of the 
neck, immediately above the sternum, arising, no doubt, from a condensation 
of the aneurismal tumour. The right carotid artery still pulsates, although not 
so strongly as the left? its pulsation corresponds to that of the heart, but its 
branch, the temporal artery, affords no indication of the circulation of blood; 
the right radial artery beats with about half the strength of the left. She suffers 
none of those pains in the regions of the neck, shoulder, and back; nor has she 
for a long time, experienced any of those severe head-aches which formerly 
gave her so much uneasiness; the oedema of the feet has entirely disappeared, 
and she takes exercise in the open air daily. 

" The above report was drawn up a month ago, previous to her visit to the 
country, from which, in a letter received from her yesterday, she states that she 
is now in a better state of health than she has been for a long time." 

This case is followed in an appendix, by the narration of one successfully 
treated, by D. Evans, Esq. surgeon at Belper. The patient, aged thirty, a 



Bibliographical Notices, 169 

butcher of athletic frame, had aneurism of the innominata and root of the caro- 
tid, reaching as high as the cricoid cartilage. A ligature was fixed on the caro- 
tid above the tumour. 

These several instances of success would seem to point out the mode of ope- 
rating, by fixing a ligature on the artery beyond the tumour, as fully justifiable, 
and indeed promising the best results in cases heretofore deemed hopeless. 

W. E. H. 



XVI. Mimoires de VJlmdimie Royale de Medecine. Tome Premier. Avec six 
Planches. Paris, J. B. Bailliere, 1828, 4to. pp. 496. 

The Royal Academy of Medicine was instituted by a decree of Louis XVIII. 
on the 20th of December, 1820, and consists of a Section of Medicine, a Section 
of Surgery, and a Section of Pharmacy, each made up of honorary, titular, as- 
sociate, and adjunct members. Each section elects its honorary, titular, and 
adjunct members, subject to the royal approbation: the associates, as belonging 
alike to all the sections, are elected by the whole academy. The institution 
has enrolled among its members nearly all the distinguished medical men of 
France, and its list of foreign associates, though comparatively small, presents 
some of the names of the most celebrated scientific and professional men in the 
world; the name of Physick stands immediately under that of the illustrious 
Humboldt, and is succeeded by the honoured and renowned names of Scarpa, 
Soemmering, Sprengel, &c. 

The volume before us is the first which has been published under the auspices 
of the academy. The first three hundred and thirty -nine pages of this large volume 
are filled with matter of comparatively slight interest, consisting of the laws of the 
academy, eulogies on various distinguished members, among whom maybe men- 
tioned Pinel, Corvisart, and Bertholet; the report of the committee on epide- 
mics, and the first report or summary of the labours of the Section of Medicine. 
However interesting it might be to dwell upon the merits of the great benefac- 
tors of science, commemorated in the above-mentioned discourses, we must 
on this occasion be content with referring to the original, and pass on to mat- 
ter more immediately of a practical nature. The Report on Epidemics is from 
a distinguished committee, consisting, among others, of Portal, Chaussier, Des- 
genettes, Larrey, Vauquelin, 8cc. charged with the formation of a plan of in- 
struction relative to epidemics. This task has been accomplished in a very sa- 
tisfactory manner, and the importance of the subject, and all the aspects under 
which it should be studied, are indicated and insisted upon with great force and 
clearness. This report should be read entire to be productive of advantage, and 
as it is highly probable we shall hereafter have an opportunity of giving a trans- 
lation of it, we shall not attempt to present a more detailed account at this 
time. A few extracts from the account of the labours of the section of medicine 
may prove acceptable to the reader, though it is possible that the subjects are 
not entirely new. 

"For a long time the muscularity of the uterus was contested, both because 
it had not been demonstrated by the knife, and because the direction of the 
supposed or demonstrated fibres could not be determined. Rutsch first point- 
ed out at the fundus of the organ a layer of muscular fibres, which he described 

No. VII.— May, 1829. 22 



170 Bibliographical Notices, 

as a new muscle, intended to facilitate the separation of the placenta. Later 
anatomists bestowed upon this, the name of the muscle of Ruysch. Weitbrecht 
discovered two layers of muscular fibres, surrounding' the uterine orifice of 
each of the fallopian tubes. He described these as two orbicular muscles. 
Jean Sue had distinguished on four sides of the womb, many points where the 
fibres were interlaced in such a manner as closely to resemble the nodosities 
of wood. These he considered as four distinct muscles, which he called quadri- 
gemini. 

"Madame Boivin, mistress-midwife, animated by the encouragement of the 
section, pushed the discovery much farther. She has remarked with exactitude 
in the texture of the organ four superposed layers of muscular fibres, dis- 
tinct and easily separable from each other. She successively determined 
and described the extent, force, and particular direction of these fibrous 
bundles upon the external surface of the uterus? she found upon the border, 
and each side of the median line a transverse order of fibres in three distinct 
bundles, one directed forward the other two backward. These three bundles, 
placed upon each other, after having transversely traversed the rounded angles 
of the organ, and furnished fibres to its anterior and lateral walls, continued, 
in becoming insulated, to form the round ligaments of the tubes, Sec. On the 
internal surface, upon the median line, before and behind, are found other 
layers of entirely vertical fibres, which also extend from the internal orifice of 
the uterus up to the fundus. Arrived at this point, -these fibres are recurved, 
and diverging, direct themselves from the centre to the circumference, crossing 
and interlacing with each other, to form around the fallopian angles the double 
layer of concentric fibres which have been made known by some anatomists, under 
the denomination of orbicular muscle of the tubes. Finally, at the internal part 
of the cervix uteri, Madame Boivin particularly remarks a sort of raphe, equally 
marked upon both surfaces of the cervix, and upon the median fine. From each 
side of the raphe arise numerous folds, regularly disposed: upon the anterior 
surface, these folds, throughout remarkable for their regularity, are formed 
like a palm leaf. On the posterior surface, the fibres also exhibit a ramified 
arrangement, though they are here more irregular. 

" Charles Bell, in England, has made similar researches; but less favoured by 
circumstances, he did not push his researches as far as Madame Boivin, so that 
part of our distinguished mistress-midwife's researches are confirmed by those 
of Bell, without losing any of their originality or merit." 

Mr. Breschet has proved, that besides the three forms of extra-uterine preg- 
nancy already known, the abdominal, ovarian, and tubular, that there is a fourth 
in which the foetus occupies a point in the thickness of the organ, while the ca- 
vity remains empty. This observation of Breschet is supported by two cases 
which occurred in France, and three analogous cases, one communicated by Dr. 
Albers of Bremen, another by Professor Schmidt of Vienna, and the third by 
Drs. Hedrich and Carus of Dresden. 

M. Barthelemy has furnished an instance of softening* of the spinal marrow 

* The word in the original is " Ramollissement" which some writers use, (as if it were untrans- 
lateable,) as an English word! What idea an English reader is to form from the word thus used, 
we can hardly imagine; or why any writer should permit himself to make use of words conveying no 
ideas, exeept to those acquainted with foreign languages, we are at a loss to determine. 



Bibliographical Notices. 171 

under remarkable circumstances. A horse was inoculated with the saliva of a 
rabid dog, became hydrophobic, and died on the third day afterwards. The 
body was examined, and the cineritious substance of the whole extent of the 
spinal marrow was very much softened, and of the colour of wine-lees. The 
membranes enveloping the spinal marrow were also much injected. M. Dupuy 
has observed the same sort of softening in hydrophobic cows, but never in mad 
dogs. 

The first paper in the second part of these memoirs is by Itard, on the 
dumbness produced by the lesion of the intellectual functions. He gives a very 
interesting account of the condition of such patients, whose dumbness is owing 
to a certain degree of deafness and a peculiar inaptitude of memory, which 
renders them unable to pronounce the names of things with which they are 
perfectly well acquainted. In general, he says this difficulty or inaptitude of 
memory to retain impressions received by the ear is not the same for all the 
sounds of the human voice; modulated sounds for instance are much better re< 
tained than spoken words. Some of these dumb, retain airs with much facility 
and hum them over with correctness. Itard was consulted in the case of a girl 
who when she attempted to speak uttered unintelligible sounds, yet could sing 
in a very correct and distinct manner a Languedoc song. He details at length 
the discipline he adopts to relieve this dumbness, by gradually teaching the 
patients to utter the names of familiar objects with which they are already ac- 
quainted by signs, and in. cases where the intellect is not otherwise defective, 
he has completely succeeded in restoring the patients to the power of speaking. 

This dumbness from amnesia is a subject of much interest; and we hope the 
time is not far distant, when we shall be aided by the light of anatomy to un- 
derstand the manner of its causation. Our readers will recollect the veiy inte- 
resting case published in our last number by our colleague, Jackson, of Phila- 
delphia. Since the publication of that case, another, strikingly similar has fallen 
within our knowledge, in the practice of a highly respectable physici?" In this 
latter case, the only symptom remarkable was the amnesia, an inability to re- 
member or utter words, either by the voice or with a pen, without the least 
impairment of the motions of the tongue, or the organs concerned in speech, 
and with a perfect understanding of all that was said, or indicated by signs. Af- 
ter depletion, this patient became able to articulate yessmdno, and after a lapse 
of several weeks he could express himself in such a manner as readily to be un- 
derstood. We hope that a proper account of this case will hereafter be given. 

The second memoir is also by M. Itard, and the subject is some cerebral 
phlegmasia, indicated as causes of malignant inter mittents. From the facts col- 
lected, M. Itard clearly shows that malignant or pernicious intermittents are 
produced by inflammations of the membranes or parts of the brain itself. Most 
of the cases related terminated fatally, and we apprehend the quinine adminis- 
tered for the (name ofjfhe) intermittent, accelerated the event. Nevertheless, 
the author concludes h#s observations in the following manner; "let us not for- 
get to remark, as a precious therapeutic fact, that in the different attacks of 
pernicious intermittent, suffered by his patient, the quinine given in large doses 
had an excellent effect, although this fever was symptomatic, and evidently 
provoked by inflammation." The patient from whose case this " precious fact" 
is obtained, had intermittent, provoked by a disease of the internal ear, which 



172 Bibliographical Notices. 

at the conclusion of the paroxysms commenced a free discharge, a circumstance 
quite sufficient to show that any deduction as to the usefulness of quinine inin- 
termittents from cerebral inflammation is altogether gratuitous. M. Itard gives 
no farther views of the subject, but contents himself with showing that the in- 
flammation of the membranes, brain, or bones of the cranium, may cause ma- 
lignant intermittent, of which there cannot be a doubt in the minds of experi- 
enced physicians. Nor do we think that any other conclusion can be drawn from 
our knowledge of the pathology of such cases, than that the treatment should 
be directed to the local inflammatory affection, without reference to the " in- 
termittent" appearance of symptoms. Happy will it be for mankind and our 
profession, when physicians shall cease to prescribe for the names of diseases, 
and devote themselves to study the actual conditions of organs in health and 
disease. 

The third memoir is by Esq,uirol, and is an examination of the question, 
whether the number of insane is greater now than formerly? All his inquiries 
and observations lead him to draw the following conclusions: — 1st. That the 
incumberment of the public establishments in France, particularly at Paris, 
does not prove that the number of insane is really augmented, more than the 
appreciation of the causes of the disease accounts for. 2d. That the exertions 
and writings of physicians, especially those of Pji*el, have powerfully contri- 
buted to awaken an interest in favour of the insane, and, consequently, has in- 
duced a belief that the number of alienated patients is augmented. 3d. That 
the improvements of all kinds introduced in hospitals destined to receive these 
unfortunates, by attracting a greater number of individuals, has given strength 
to this opinion. 4th. That since the augmentation of the number of insane pa- 
tients is only apparent, it is not true that mental alienation is a calamity belong- 
ing to the present times. 

The fourth paper is an elaborate inquiry relative to the mortality in France, 
of the richer and poor classes, by L. R. Villerme, and abounds in details and 
observations of great interest. We must confine ourselves merely to the con- 
clusions the author has drawn from the facts, whjch."-«ire as follows: — 

There die in the rich departments 20-100ths individuals at 1 year old; and 
22£-100ths m the poor.— At 4 years, 31-lOOths of the rich, and 35-100ths of the 
poor, — At 10 years, not quite 38-100ths rich, and 44-100ths poor. — At 20 years, 
rather more than 42-100ths rich, and 49-100ths, that is, nearly one-half of the 
poor. — At 40 years, 54-100ths rich, and 62-1 OOths poor. — At sixty years, 68^-100ths 
rich, and 78-100ths poor. — At eighty years, 93-100ths rich, and 96-100ths poor. — 
At 90 years of age there remain 82 individuals of 10,000 inhabitants in the rich 
departments, and not more than 53 from the same number of poor. 

The excess of mortality among the poor is observed at all ages; it is greater 
among old men than among individuals in the vigour of life, and still more par- 
ticularly among very young children. The mortality among the foundlings is 
so great, notwithstanding the ardent zeal of charity, which, however, can never 
supply the want of the mother's milk, nursing and superintendence, that in 
Paris 60 perish during the first year after birth out of every 100; and frightful 
as this morality is, it is the most favourable which has ever been obtained by 
the establishments of foundling hospitals in the capital. 

The ensuing memoir is by V. Bally, on the therapeutic effects of morphine 



Bibliographical Notices. 173 

or narceine. In our last number, (p. 457,) a summary of M. Bally's conclusions 
on the use of morphine will be found. It is therefore unnecessary to repeat 
them here, though we can state with great satisfaction, that the memoir will 
amply compensate the reader for the most attentive perusal. It is one of the 
most elaborate and carefully conducted investigations which we have read for 
a long time, and proves its author to be a most patient and philosophical ob- 
server, as well as a judicious and excellent practitioner. 

Doctor Leveille next gives an ample memoir on the drunkard's delirium, 
delirium tremens, of various writers, in which he gives a veiy excellent ac- 
count of the disease, and the modes of treatment. That by the administra- 
tion of opium, now most generally resorted to in this country, he prefers, and 
has found to be almost uniformly successful. In passing he treats of various to- 
pics connected with delirium tremens, in an interesting manner. There is no- 
thing, however, very new or very striking in his views to require that they 
should be repeated here. Dr. B. H. Coates, of Philadelphia, has published the 
best observations which have yet appeared on this subject, and his paper has 
furnisfied a large part of what has since been written concerning this disease in 
Europe. 

The first memoir from the section of surgery is by the justly celebrated Ba- 
ron Lahrey, on penetrating wounds of the chest, in which he indicates the 
treatment he has been led to adopt, and which his prolonged experience con- 
tinues to assure him is the best in such cases. We subjoin a statement of a 
highly interesting case, exemplifying its propriety. 

Antoine C. a soldier, twenty-six years of age, was brought to the hospital on 
the night of the 21st of October grievously wounded. Being very much pros- 
trated when he was brought in, on account of the enormous quantity of blood 
which immediately followed the wound, the surgeon who received him applied 
a simple dressing, gave him a cordial draught, caused his body and limbs to 
be warmed, and left him in charge of an intelligent nurse. 

" On visiting Mm next morning I found him in imminent danger, he was 
speechless, his visage pale and. disfigured, pulse scarcely perceptible, respira- 
tion short, laborious, and almost insensible, the dressings of the wound were 
filled with florid blood, and his debility was extreme. Carefully removing the 
bandages, two large wounds were discovered, opposite to each other, on the 
right side of the chest, which, one of the bystanders said, were made by a foot 
soldier's sabre, f called spadon,J with a very keen edge. The anterior wound 
was a transverse cut, situated below and a little beyond the right nipple, 
whence, passing obliquely backward, it traversed the centre of the right cavity 
of the chest. In its passage the weapon had divided a large part of the lung, 
and the root of the intercostal artery. The point of the sword came out at the 
interval of the third and fourth ribs, in the hollow of the armpit of the same 
side, between the anterior edge of the scapula, and the tendon of the latissimus 
dorsi, which was cut very close to its insertion into the humerus. 

'* The patient being put to bed in a separate chamber we proceeded to dress 
the wounds: I first dilated both wounds with proper precaution, and by intro- 
ducing my finger found that they both penetrated the cavity of the chest through 
the intercostal space above-mentioned, but in such a manner, that the strip of 
intercostal muscles, interposed between the entrance and the exit of the sabre ? 



174 Bibliographical Nolices. 

was cut throughout that extent, even into the thickness of the serratus; and the 
depth of this cut enabled us to verify the injury of the internal parts as already 
stated. The intercostal artery appeared to be cut off near to its origin from the 
pectoral aorta; nevertheless the haemorrhage was suspended, but the vessels of 
the lung's still furnished a considerable quantity of florid and frothy blood. The 
wounds being dilated, and the blood effused into the surrounding cellular tex- 
ture expelled, the wounds were united by adhesive straps covered by compress 
and bandage. 

" Frictions over the limbs and belly, with heated camphorated oil of chamo- 
mile, were ordered: he was then enveloped in flannels, and directed to make 
use of mucilaginous drinks. I scarcely expected to see this patient alive at my 
next visit; however, in the evening I was surprised to hear him conversing with 
vivacity; the internal haemorrhage had certainly ceased, and the organic func- 
tions were developed. 

" On the 22d the pulse was feverish, but small, the respiration short and labo- 
rious; the patient was in a state of painful anxiety. The dressings were slightly 
wet with a reddish serosity, were left undisturbed, and the use of the mucila- 
ginous drinks continued. On the night of the 23d, symptoms of irritation and 
inflammation coming on, the house-surgeon bled him freely, and applied a 
number of cups to the epigastrium, which afforded relief. On the 23d the 
dressings were removed; the edges of the two wounds were found united, and 
the patient's condition was more promising; he had expectorated during the 
night a considerable quantity of black blood. Respiration was less laborious, 
and he spoke with greater ease; the treatment was ordered to be continued, 
and the patient to be kept perfectly quiet. On the morning of the 24th, feel- 
ing much better, he ate a large piece of bread and meat which he had received 
from one. of his companions, unknown to the nurse, he committed this impru- 
dence at the moment of taking a dose of nitre whey. The stomach was imme- 
diately struck with torpor, and the patient, seized with an icy coldness, fell 
into a state of extreme weakness, and inexpressible distress. The attending 
surgeon being informed of the cause of his condition, gave him an emetic solu- 
tion, which freely evacuated his stomach, but the violent efforts made in vomit- 
ing broke open the orifice of the intercostal artery, and the vessel in the lungs 
divided by the sabre, as in a few moments after the patient was seized with an 
extreme oppression, loss of speech, great difficulty of breathing, spasms, and 
all the signs of approaching suffocation. The corresponding side of the chest 
was also much distended, and the pulse disappeared. It was evident from the 
symptoms that a new effusion had suddenly taken place, by a renewal of hae- 
morrhage from the same vessels. I contented myself at present with applica- 
tion of dry cups to the chest, and renewal of the dressing, as we apprehended 
his immediate death. I perceived the urgent necessity of making a counter 
opening, as in the operation of empyema, but the desperate state of the pa- 
tient caused me to defer it until next day. The patient was very restless dur- 
ing the night, but had somewhat recovered strength. On my next visit I 
believed the internal haemorrhage again arrested; and I determined to per- 
form the operation. Several physicians present disbelieved the exist- 
ence of the effusion, and were extremely surprised at the operation per- 
formed in their presence, and at the quantity of fluid drawn off, which 



Bibliographical Notices. 175 

in a few minutes filled two bowls holding about five litres, with a fluid 
resembling 1 lees of wine, mixed with small clots of blood. Before operat- 
ing 1 , I took care to recapitulate the signs which characterize the effusion? 
such are (edematous engorgement, with blackish, (ecchymosed,) lines behind 
the right hypochondrium, immobility, and considerable separation of the ribs 
on the same side, extreme oppression, total absence of respiration in the cor- 
responding lung, smallness of pulse and beating of the heart, which could only 
be felt by means of the stethoscope at the most distant point of the left hypo- 
chondrium. I was careful to empty the whole sac of the pleura, by means of a 
gum elastic tube. The wound was then dressed, and a very light diet pre- 
scribed. 

"The patient found himself better, but his extreme debility left little hope 
of his recovery. Frictions of warm camphorated vinegar were frequently re- 
peated over the whole surface, and the limbs rolled in flannel. He passed the 
night somewhat calmly, and on the morning of the 28th we found the dressings 
soaked with bloody fluid. A gum-elastic tube introduced into the wound again 
gave issue to about a demi-litre of serosity mixed with grumous blood. 

"A repetition of imprudence caused fever, violent pains in the chest, delirium, 
and a paralytic affection of the lower extremities. Extensive cupping about the 
neck, shoulders, and dorsal region, the application of ice to the head and mus- 
tard to the feet, eventually relieved him. The wounds were dressed twice a 
day, and the stimulating frictions continued. All the unfavourable symptoms 
had disappeared by the fifteenth day, and the wounds made by the sword were 
cicatrized. 

" The sanguinolent fluid from the opening made into the chest by the ope- 
ration, changed to a laudable pus in moderate quantity, frequently mingled 
with albuminous and membraniform flocks, doubtless resulting from the exfoli- 
ation of the layers of the pleura surrounding the cavity containing the effusion. 
During the suppuration, which was prolonged for several months, he had all 
the symptoms of the highest degree of phthisis, sometimes with mucous diar- 
rhoea. He was fed on mild mucilaginous diet, occasionally took small quantities 
of sulphate of quinine, and was especially benefited by repeated applications of 
moxa. We always remarked, that in suspending the febrile action, the moxa 
augmented the action of the organs, diminished sensibly the purulent secretion 
from the ulcerated surfaces of the lungs and pleura, and favoured the approxi- 
mation of the walls of the chest and the process of the internal cicatrization. 

We see in this patient all the phenomena observed in several others upon 
whom the operation for empyema has been successfully performed. Thus, in 
our wounded soldier, the whole circumference of the injured side is reduced 
to half of its original size; the curvature of the ribs is greatly diminished, and 
they are in immediate contact; the shoulder on the injured side is lowered; the 
trunk is inclined in the same direction; the heart has" followed the displacement 
of the mediastinum to the right side, so that its pulsations are no longer per- 
ceptible on the left, but are to be felt opposite to the cartilages of the 8th and 
9th ribs of the right side. The diaphragm is considerably raised on the right 
side with all the viscera attached to its arch. The position of the lung, re- 
maining at the upper part of the chest, is certainly hepatized and augmented 



1 76 Bibliographical Notices. 

in size, to aid in obliterating- the enormous void left by the evacuation of the 
fluid from the thoracic cavity. The axillary nerves and vessels, enveloped in 
an almost inorganic fleshy mass, have produced a wasting of the whole arm ; the 
left cavity of the chest has dilated in equal proportion to the diminution of the 
right, and the parenchyma of the lung has increased to twice the original di- 
mension. The left ribs are more curved and wider apart than natural, and re- 
spiration is exclusively performed on the left side. The whole physical con- 
dition has suffered a metamorphosis, and the function of the respiratory and cir- 
culatory organs have undergone remarkable modifications, yet so happily 
adapted, that the life and health appear as firmly re-established as they were 
before the injury. 

Next follows a paper by Baron Larrey, on the operation of lithotomy, in 
which he endeavours to show that different kinds of calculus, &c. requires dif- 
ferent modes of operation. He publishes the history of a case in support of his 
views, and concludes his paper by some very interesting reflections on litho- 
tomy in general. 

The last memoir we have room to notice especially, is Baron Dupuytren's ac- 
count of his treatment of artificial anus. It is a long and satisfactory paper, 
which would be read by every surgeon with interest. As his mode of operat- 
ing is already well known to our readers, we shall dwell on the fact, that he 
has in this paper done tardy, though still imperfect justice to Physick, who an- 
ticipated Dupuytren's in this part of surgery. After quoting in a note what is 
said of Physick's operation anon in the second edition of Dorsey's Surgery, he 
adds — " The operation of Physick, then, like that of Schmalkalden, (performed 
in 1798,) consists in a perforation of the partition separating the two ends of 
the intestine made with needles, thread and loopes, and is incontestably ana- 
logous to my operation upon Aucter." Now in fact the operation by Dr. Physick 
is identical in effect with Dupuytren's, and the only difference between them 
is that the latter effected the division with an irregular pair of forceps, while 
the former did precisely the same with the ligature 5 differing only in the instru- 
ment — not at all in principle. 

The papers from the section of pharmacy are long and sufficiently numerous, 
but we are unable to enter into farther details at present, especially as the re- 
maining memoirs are not recommended by any very practical importance. 

J. D. G. 



XVII. A Treatise on the Nature and Cure of Intestinal Worms of the Human Body; 
Arranged according to the Classification of Rudolph and Bremser, and co?itain- 
ing the most approved methods of treatment, as practised in this country, [Eng- 
land,] and on the continent [of Europe.] Ry William Rhind, Surgeon, Mem- 
ber of the Royal Medical Society of Edinburgh. Illustrated by six plates. 
London, 1829, pp. 142. 

This is the first work upon the subject of intestinal worms, in the English 
language, that may be regarded by the physician and naturalist as laying 
claims to accuracy and finish. It is true that, the external appearances, and 
even anatomical structure of some species have been described by Hooper 



Bibliograj)h ical Notices. i 77 

and others,* but. still much was wanted to complete the history, symptoms, and 
method of cure, not only of these, but of various other species met with in 
other cavities and textures of the body. The present treatise was intended 
by Mr. Rhind to supply the deficiencies existing" upon this subject. 

The presence of worms in various parts of animals, our author attributes 
to the disposition manifested by nature to multiply and support animal ex- 
istence under every variety of circumstance as well as every possible situa- 
tion, all beings however small, having 1 others still more minute depending 
upon them for nourishment. Of these parasites, Rudolphi has enumerated 
no less than eleven hundred different species as found among the various 
classes of the animal kingdom. Of worms, some are common to several classes 
of animals, whilst others again frequent only one particular species. For ex- 
ample, the large, round worm of the human species is also to be met with in 
pigs, horses, and cows; whereas the two species of tape-worm found in the 
human body, are distinct from those of all other animals. Every different ani- 
mal structure is liable to be tenanted by some species of animal, which for the 
most part is peculiar to it. 

In support of the position that the intestinal worms of the human body 
are of a kind different from any of similar appearance found existing in earth 
or water, Mr. Rhind refers to their distinct and peculiar formation and struc- 
ture, their living and propagating in the body, and their incapacity to sustain 
life for any length of time when removed from it. With regard to the much 
agitated and perplexing question of the origin of worms, our author combats 
the opinion held by Bremser, of their spontaneous formation, as contrary to all 
analogy drawn from nature, there being no similar instance of spontaneous pro- 
duction in any other class of animals. He at the same time acknowledges the 
very great difficulty there is in accounting for the existence of various species 
of worms found in certain cavities of the body, excluded from any direct exter- 
nal communication. "Yet," says he, "it is possible the extremely minute 
ovula or eggs of these animals, may be carried to these cavities by the absorbent 
vessels through the medium of the blood-vessels, or by some of those animals 
puncturing and penetrating the external skin, as is supposed to be the case 
with the Jilaria medinensis, or Guinea worm." 

Our author maintains that a peculiar state of the body and of the intestinal 
canal in particular, is necessary for the development of worms, and aptly illus- 
trates his view by a reference to the manner in which various vegetable seeds 
are carried about by the winds, rest themselves in particular spots which suit 
their nature, where they spout and shoot up. It is well known that some of 
these seeds may remain buried for years, and still retain their life and power of 
vegetating under favourable circumstances. The eggs of a silk-worm-moth put 
into a wooden box, and placed in a damp cellar, were kept there by Captain 
Brown for two years, when on being placed in the sun, they were speedily 
brought to the larva or caterpillar state. 

The disposition in the human body which our author thinks most prone to the 
affection of worms, is a general laxity and debility of the whole system, but 

* Dr. Hooper's paper upon the subject, may be seen in the Memoirs of the London Medical Society, 
Vol. 5th. 

No. VII.— -May, 1829. 23 



178 Bibliographical Notices. 

more especially of the intestines. An imperfect digestion of the food and % 
deficiency of the various juices necessary for converting- this food into nourish- 
ment, or an over active digestion producing 1 more alimentary matter than the 
absorbent vessels can take up, are both equally favourable. This last circum- 
stance may be the cause why robust and healthy people are sometimes found 
troubled with this affection. Some have entertained an opinion that the in- 
habitants of cities are more liable to worms than those of the country; and 
again, that animal food is more favourable to their production than vegetable. 
Bremser, however, states that he has frequently found in the graminiverous 
animals, great numbers of intestinal worms, and imputes the greater prevalence 
in the inhabitants of cities to luxurious living, want of due exercise, and conse- 
quent derangement of the digestive organs. 

Relative to the influence of diet, it may be stated in a general way, that all 
crude vegetables and unripe fruits, especially when freely taken, as also 
a milk diet, and too much saccharine matter, are favourable to the produc- 
tion of worms. Our author likewise thinks it probable that a diet not suffi- 
ciently stimulating, as one entirely composed of farinaceous and vegetable mat- 
ter, may be followed by the same consequences. Salt, from its stimulating 
qualities, is known to be a preventive. Lord Somerville, in his address to the 
Board of Agriculture, relates the following circumstance : — " The ancient laws 
of Holland ordained men to be kept on bread alone, unmixed with salt, as the 
severest punishment that could be inflicted upon them in their moist climate. 
The effect was horrible; these wretched criminals are said to have been devour- 
ed by worms engendered in their stomachs." 

It is well known that the inhabitants of some countries are peculiarly liable 
to worms. The Germans, the inhabitants of many parts of France, the Italians, 
and Tyrolese, are extremely subject to the Taenia solium or common tape-worm. 
In Russia, Poland, and Sweden, again, the Tsenia lata, or broad tape-worm pre- 
vails. The former species is most common in England. 

According to the classification adopted by our author, the first species of 
worms inhabiting the intestinal canal is the Trichocephalus dispar or long thread- 
worm. This, when full grown, is from one and a half to two inches long, and 
about the sixteenth part of an inch in breadth. It is generally found in the 
large intestines, and most frequently in the ccecum. About two-thirds of its 
length is small or capillary, the head being situated at the termination of this 
small portion, from which circumstance it has derived its generic name of tricho- 
cephalus or hair-headed. It appears to have been first discovered by Roederer 
of Gottengen in the year 1761. The small capillary portion having then been 
mistaken for the tail of the animal, he named it trichuris or hair-tailed. The 
French call it le ver d queue. This species is oviparous, and consists of a male 
and female. 

The second species is the Oxyuris vermicularis, the maw or thread-worm. 

The male of this is commonly from a line to a line and a half in length, and 
about the thickness of a piece of fine thread, very elastic and of a white or yel- 
lowish colour. The female is larger and longer by three or four lines. They 
are most commonly found in the rectum, though met with in the coecum and 
colon. Children are most subject to them. 

The third species is the Ascaris lumbricoides, or long round worm, which is 
so common as to require no particular description. This worm is distinct from 



Bibliographical Notices. 179 

the common earth worm, with which it has been classed. It infests the small in- 
testines, especially the jejunum and ileum, from which it frequently ascends 
into the stomach and oesophagus. 

The fourth species is the Bothriocephalus lotus, or broad tape- worm. 

This consists of a head, a chain of articulations, and a small rounded tail. 
Each link or articulation is broader than long-. Though rarely exceeding fifteen 
or twenty feet, they are sometimes found more than double that length, so as 
to occupy the whole intestinal tract. Boerhaave mentions one, voided by a Rus- 
sian, thirty yards long. Three, four, and sometimes more, have occasionally 
been found in the same person. The breadth varies from an eighth to a quarter 
of an inch. 

The fifth species is the Tsenia solium, or common tape-worm. 

This is usually found in the small intestines, and may be distinguished from 
the preceding by the more irregular structure and form of the joints, which 
are in general longer than broad, and of an oval or irregular shape. They have 
been often compared in appearance to large cucumber seeds. Tseniae of twenty 
and thirty feet long are by no means rare. The belief long entertained that 
only one of these worms was to be met with in the same person, gave rise to 
its name? but this opinion has been proven erroneous. It is generally supposed 
that these worms are hermaphrodite; at all events their organs of generation 
have never been distinctly seen. Both species of tape worm are much more 
common to adults than children. 

Having thus given a brief notice of the five species of worms which infest the 
intestinal canal, in the order they have been arranged by Rudolphi, we regret 
that we are compelled to pass over much curious and interesting intelligence 
which our author has collected relative to various species of worms found in the 
other structures and cavities of the body. 

Without specifying any of the multitude of symptoms regarded as indicating 
the presence of worms, we shall follow our author to his "method of cure." 
His chief intentions differ in no way from those of practitioners generally, 
namely, the destruction and expulsion of worms, and the correction of the par- 
ticular states of the general system and intestinal canal which has favoured their 
formation. 

Among the various medicines enumerated as fitted to cause the death of 
worms, he mentions iced water as capable of quickly destroying them. But in- 
asmuch as this can only be applied in the form of enema, its use is consequently 
very limited. In the treatment of the two species of thread worm common to 
the lower portion of the intestinal canal, he observes that medicines given by 
the mouth are apt to lose their effects in the course of the long passage which 
they are obliged to take through the bowels. For this reason, injections are 
most to be depended on. He, however, recommends aloes, in doses of two, 
three, or six grains, taken every morning, since this medicine is well known to 
pass through the small intestines without experiencing much change, and to 
act particularly upon the coecum and rectum. Dr. Bremser recommends in ob- 
stinate cases, the fumes of tobacco, or an enema of the infusion of male fern. 
These worms are known to increase with astonishing rapidity. 

As to the other means recommended by Mr. Rhind for the destruction and 
evacuation of worms infesting the lower intestines, there does not appear to be 



180 Bibliographical Notices. 

any thing sufficiently novel to merit particular notice here. The same observation 
will apply to the mode of treatment he recommends for the long- round worm. 
He considers a similar method as applicable to both species of tape worm, which 
he looks upon as the most injurious to the system and difficult to dislodge of 
all others. Our author details the treatment so much vaunted by Bremser as 
so effectual not only in this but in all other species of intestinal worms. This 
consists chiefly in the use of Chabert's empyreumatic oil, which he says is 
composed of one part of empyreumatic animal oil, (from hartshorn,) and three 
parts of oil of turpentine, distilled together in a retort in a sand bath, till three- 
fourths come over. The taste of this medicine, he says, is nauseous, and it is 
apt to produce griping and very frequently irritation of the bladder and stran- 
gury. The dose usually recommended is two tea-spoonfuls morning and night. 
He thinks that the chief virtue of this nostrum resides in the oil of turpentine, 
the efficacy of which well known vermifuge he believes may be increased by 
conjoining it with castor oil, as in the following formula: — R. ol. terebinth, spj. 
ol ricini, %j. mucilage g. arab. ^ss. syrup, simp. gss. M. To be taken divided 
into two or three doses. He thinks that the addition of the castor oil confines 
the operation of the oil of turpentine to the bowels and makes it less apt to act 
upon the urinary apparatus. This medicine must be cautiously administered at 
first, as some may not be able to bear more than thirty drops of the oil of tur- 
pentine at a dose, whilst others may take with impunity two drachms or more. 
After a perseverance in this medicine, in doses just sufficient to keep up a mo- 
derate but continued operation upon the bowels, all traces of worms having dis- 
appeared, the next thing to be done is to endeavour to prevent their future for- 
mation. For this purpose, if the patient be of a weak habit, he recommends, 
among other prescriptions, the following draught: — R. sulph. quinin. gr. ij.acid. 
sulphur, aromat. gtts. xxv. aq. fontis, sjij. M. To be taken morning and noon. 
Or this powder: — R. carbon, ferri. gij. pulv. rhei. gss. pulv. colomba, gij. Mice 
et divid. in pulv. xii. One to be taken twice a day, in a little jelly. 

Upon the whole, we look upon the treatise of Dr. Rhind as more likely to 
interest the physician versed in natural history, than the practitioner who may 
attach less importance to the attainment of science, than to the acquirement 
of new practical knowledge. It seems especially adapted to aid the student in 
his research. 

The drawings which accompany the work add greatly to its value. Indeed, 
without such assistance, it would be far less attractive and useful. From the 
facility with which accurate delineations can be multiplied by the art of litho- 
graphy, it seems destined to lay our profession under special obligations. The 
figures in the present work represent the objects treated of, not only of their 
natural size, but as they appear when strongly magnified. The black ground 
on which they are represented, exhibits them with peculiar distinctness and al- 
most of their proper colour. G. E. 



XVIII. De I' Irritation et de la Folie, ouvrage dans lequel les rapports du Physique 
et da Moral sont Stablis sur les bases de la Mtdecine Physiologique. Par F. J. 
V. Broussais. Paris, 1828. pp. 590. 8vo. 

The history of the medical art proves, that like other branches of learning, 



Bibliographical Notices. 181 

it has had periods marked by a general and absorbing influence exercised 
over it by some of the collateral sciences. The almost despotic sway of some 
particular science over others, has been highly detrimental to their progress, 
and it has been an unfortunate circumstance that their proper sphere of ac- 
tion and usefulness has not been more undeviatingly attended to, and that each 
has not been restricted, where alone it could prove beneficial, and prevented 
from encroaching too far on the boundaries of others. Thus medical systems 
have put on different appearances, according to the various lights they have 
received from other sciences, but these reflected rays were too feeble in them- 
selves to dispel the darkness, and have only produced illusion. Metaphysics, me- 
chanics, and chemistry have each in turn influenced the theories and practice 
of the healing art; but this state of things we trust is now at an end, as medicine 
appears to be at last assuming the only direction that can establish it on incon- 
trovertible principles: that of a close and sedulous investigation of the actions 
of external agents on the human system, and of the reciprocal relations of the 
organs to each other, in health and disease. It is to the lights afforded by phy- 
siology and pathology that we must look for the dispelling of the numerous 
errors which still exist in the practical part of our profession, as these are the 
only sure and certain guides to that perfection so ardently to be desired. The 
good effects of this method of viewing disease, are even now becoming strikingly 
prominent, and we are daily presented with results which a few years since 
could scarcely have been anticipated. 

We have been led into these remarks, by the perusal of the work whose title 
we have just given. To the learned and indefatigable author, medicine is 
deeply indebted for the impetus he has given to physiological pursuits, and for 
the sound practical views he has taken of the effects of disease on the different 
tissues of the body. In the present treatise, he has endeavoured to apply the 
principles of physiological medicine to the elucidation and treatment of diseases 
of the mind; and we are sorry to be obliged to say that he has not been as suc- 
cessful or lucid as in his former labours. So long as he confines himself to ac- 
counts of symptoms, morbid changes, and practical precepts, the work merits 
great attention, but when he enters on the consideration of the mind and its 
properties, he becomes involved in a tissue of metaphysical subtleties, as wild 
and visionary as any of those which have obscured the reasonings of his pre- 
decessors. 

The philosophy of M. Broussais is of the same character as that of Cabanis 
and Lawrence, and approaches closely to materialism: it is of course strongly 
opposed to the doctrines of the Scotch school, or, as he terms it, the Kanto- 
Platonic. The object of the work, as stated in the preface, is to claim as apper-. 
taming to the domain of physiology, all that part of the study of man which has 
hitherto been considered as belonging to metaphysics, and to impress on the 
mind of physicians the absolute necessity for a close investigation of the 
human intellect on physiological principles, as well as to prove the close 
and intimate connexion existing between diseases of the body and those of the 
mind. 

The work is divided into two distinct parts; the first of which is devot- 
ed to the consideration of irritation generally, and is the most speculative, 



182 Bibliographical Notices. 

and contains the exposition of the author's views as to the operations of the 
mind; the second is on alienation of mind, and the application of these princi- 
ples to its causes and treatment. It would be impossible in the short space 
allotted to this notice to enter into a particular consideration of the different 
divisions of the work, this, however, is the less necessary, as we are fully per- 
suaded that the importance of the subject will induce most of our readers to 
consult it for themselves. His leading points may be given in a few words, and 
will more fully display the ground he has taken than any observations we can 
offer. 

Irritation or excitation is necessary, in the opinion of our author, to our ex- 
istence; this irritation is kept up by the various agents amidst which we live, 
and which are constantly exercising an influence on our organs; from the sur- 
faces of these organs, whether they are internal or external, the excitation is 
transmitted to the nervous system, which, by its branches, or by its centre, the 
brain, again reflects it through all the tissues. It is in consequence of the con- 
tinual influence of the various causes of excitation that life is maintained, should 
these be abstracted, death is inevitable; in fact, the manifestation of all the phe- 
nomena which form what is termed life, as movement or contractibility, and the 
perception of this action, or sensibility, may be referred to this cause; on these 
two principles all the others depend, as the production of animal heat, nutri- 
tion, &c. Our author then goes on to say, that vital action, vital properties, 
and the vis medicatrix naturae are only abstract ideas having no real existence; 
that the formation of the embryon is due to a kind of living chemistry, (chimie 
vivante;) and that the cerebral system is only a living matter, (matiere vivante;) 
that there is no such operation of the mind as the formation of innate ideas, the 
only perception we have is of things. He also thinks that all the instinctive 
and intellectual phenomena are dependant on the action and excitation of the 
nervous system; that thought being a species of irritation of the brain, its essen- 
tial principle depends on the irritability of the cerebral substance, hence all the 
moral motions are really organic, and the terms sensations, perceptions, and 
ideas only mean certain states or modes of excitement of the nervous system. 
Intellect or intelligence is not, however, an effect or result of this excitement, 
but is only a species of this very excitement; hence all intellectual phenome- 
na are the result of the actions of a perishable animal substance. 

It will be perceived, from the above extract, that M. Broussais is a pure ma- 
terialist, attributing, in the first instance, the formation of living beings to a spe- 
cies of chemical process, and all the nobler attributes of our nature to a nerv- 
ous irritation. But he goes farther and asserts, that man is not a free agent, 
that his will, as well as all his perceptions and ideas, are all influenced and di- 
rected by irritation or excitement existing in various parts of his system, or that 
man is in fact an automaton, all of whose actions depend on the influence of 
physical agents; should this doctrine, which is that of Spinosa, Hobbes, and 
Owen, be correct, all law and moral obligation is worse than useless, as crime 
could not be imputed to a being whose reason was but a species of nervous ir- 
ritation, over which he had no control. But we will leave this part of the 
work, and proceed to the examination of the secon4 division of it, or the ap- 
plication of physiological principles to diseases of the mind. We have not at- 



Bibliographical Notices. 183 

tempted to analyze the author's ideas on irritation and inflammation, as occur- 
ring- in the different tissues, and constituting disease, as these are too well 
known to need comment. 

Chapter I. is on the Causes of Alienation of Mind. — These, says M. Broussais, 
may be classed in the same manner as those of all other diseases, that is to say, 
they depend on the influence of the vital actions themselves, and on that of 
other organs on the brain, but as the action of all these causes does not neces- 
sarily produce insanity, a certain predisposition must be admitted, this arises 
from an excessive irritability of the brain, or from its vicious development. 

Chapter II. On the Incubation of Insanity. — There are two kinds, one cere- 
bral, and the other non-cerebral; the first depending on the actions of the or- 
gan itself, and the other on the excitation transmitted by means of the nerves 
from other parts. Both these may be either chronic or acute. Females are more 
liable to alienation of mind than males, not only from their greater irritability, 
but also from their possessing a less development of the brain in those regions 
which preside over the intellectual faculties. 

Chapter III. Character of Insanity. — Our author divides alienation of mind 
into, 1st, acute mania, of which the varieties are, a, acute and furious mania; 
b, acute mania without fury. 2d. Chronic mania: this is either general or par- 
tial; the last being the monomania of late authors, and the melancholia of the 
ancient. M. Broussais enters at some length into the consideration of this form, 
and divides it into many species and varieties. 1st. Monomania, founded on a 
perversion of the instinct, and of the physical attributes, with or without deli- 
rium; the varieties of this are — a. Perversion of the attribute of self-preserva- 
tion, or suicidal monomania: one form, our author says, arises in most cases 
from disease of the stomach, also implicating the heart and lungs, b. Perver- 
sion of the instinct for muscular action or rest. c. Perversion of the natural in- 
stinct of association with our fellow beings. This perversion and that of suicide 
are often united; it generally depends on an irritation of the trisplanchnic ap- 
paratus, and more especially on that of the stomach, d. Perversion of the in- 
stinct of nutrition. This is manifested in bulimia, and in those who are fond of 
feeding on extraordinary and disgusting articles; this form also depends on a 
disease of the stomach, e. Perversion of the instinct of generation. This may 
exist in several forms. 2d. Intellectual monomanias, or those founded on the 
perversion of the moral faculties, and on the predominance of a single, or a se- 
ries of acquired ideas. This species of monomania is also divided by M. Brous- 
sais into several varieties, as, a, monomania founded on self-esteem. This pre- 
sents numerous forms; the persons afflicted with it believing themselves to be 
emperors, prophets, &c. or it may assume the appearance of inordinate vanity. 
b. Monomania from self-degradation. This form is the opposite of the last men- 
tioned; all those affected with this variety are at the same time subject to a 
violent and obstinate irritation of the digestive organs; this irritation may, how- 
ever, be produced from the effects of grief and terror, c. Monomania with 
gaiety, d. Monomania with grief and depression. This is the melancholia of 
ancient writers, and the lipemania of Esquirol. e. Complicated monomanias. 
These are characterised by a predominance of a series of ideas giving rise suc- 
cessively to the most opposite sensations. /. Intellectual monomanias without 
any predominance of internal emotions, whether agreeable or otherwise. These 



1S4 Bibliographical Notices. 

are extremely numerous and diversified; the last form is that of intermittent 
mania; this may occur in all the above-mentioned varieties. 

Chapter IV. is devoted to the consideration of the Progress, Duration, Compli- 
cation, and Termination of Insanity. — This is an extremely interesting chapter, 
although it is one which, from its nature, will not bear analysis; we will, how- 
ever, attempt to give the author's views of the natural termination of insanity. 
This, says he, is always in dementia and paralysis; which are announced by three 
classes of symptoms corresponding to the three great functions of the brain: 
the loss of the intellectual faculties, the loss of muscular motion, and the loss 
of the senses; the first constituting dementia, and the two latter paralysis; when 
insanity is complicated with epilepsy, the loss of the intellectual faculties 
takes place at an earlier period than it would otherwise have done: when 
insane patients do not fall victims to some acute attack, as of apoplexy, or 
gastritis, they generally live for a length of time, and at last perish in a mi- 
serable condition, either from general paralysis, or by some chronic affection 
and disorganization of the lungs or digestive organs. Those patients who are 
subject to rheumatic pains, are often destroyed by the formation of an aneu- 
rism of the heart. 

Chapter V. Appearances on Dissection. — As may be readily supposed, the 
greatest alterations are to be met with in the brain, although morbid appear- 
ances are generally perceptible in other organs, particularly in chronic cases. 
In a late work by Dr. Burrows, is the following table of appearances presented 
on dissection, drawn up by Pinel, and comprehending the observations of Es- 
quirol, Villermai, Beauvais, and Schevilgac. 

No diseased appearances visible in the brain, chest, or abdomen, 65. — Apo- 
plexy, 27. — Substance of the brain diseased, 19. — Membranes diseased, 22. — 
Chronic peripneumonia, 20. — Phthisis, 22. — Chronic peritontis, 9. — Chronic 
pleuritis, 7. — Chronic enteritis, 50. — Bowels otherwise diseased, 13. — Liver 
morbid, 5. — Kidneys morbid, 3. — Ovaries morbid, 2. — Uterus, 4. — Total, 259. 
This table strongly corroborates the idea that many of these lesions are poste- 
rior to the development of the insanity, and have not occasioned it. 

Chapter VI. Theories of Insanity. — These have been extremely numerous; 
Cullen, Willis, Crichton, Good, &c. believing that insanity depends on a spe- 
cific diseased action of certain minute vessels, secreting the nervous fluid, whilst 
Portal, Dumas, Cabanis, Pinel, Fodere, &c consider that it is owing to some 
morbid state of the abdominal viscera. Bayle, Calmeil, and Falret, on the con- 
trary, are of opinion that it arises from an organic derangement of the brain or 
its membranes, and Bichat, Soemmering, and Majendie, have explained it by 
the sympathetic affinities of the ganglionic nerves. But it would be an useless 
and endless task to quote all the various theories which have at different times 
been prevalent as to the causes of alienation of mind. 

Chapter VII. Theory of Insanity, according to the Physiological Doctrine. — 
This is an application of the principles insisted on in the first portion of the 
work; namely, that there are four principal forms of irritation; the inflamma- 
tory, the hemorrhagic, the sub -inflammatory, and the nervous; of these, the lat- 
ter is the most powerful, and gives rise to the others. The brain, as has been 
before stated, being subjected to two orders or kinds of excitations, those de- 
rived by the nerves of the senses from external objects, and those received from 



Bibliographical Notices. 185 

the nerves of the internal organs. These excitants, if they should act with too 
much energy, or for too great a length of time on the principal organs, which are 
all abundantly supplied with nervous branches, also exercise a powerful effect 
on the brain, causing a morbid action and derangement of the faculties. 

Chapter VIII. Prognosis of Insanity. — This is to be drawn from its causes, 
the constitution of the patient, the form of its attack, its progress, and its com- 
plications. That arising from accidental causes always offers a greater chance 
of cure than those which are caused by predisposition or long-continued morbid 
action or lesion of the brain. If we are to judge of the curability of the insane 
by the tables which have been given by different authors, it will be found that 
in well regulated hospitals, the proportion of cured is about one-fourth, some- 
times even one-third. The curability as regards age also presents some cu- 
rious results; it appears that from ten to twenty years of age, more than one- 
half of the patients recover; from twenty to thirty the chance of cure diminishes; 
this gradually decreases till in those from sixty to seventy years old, scarcely 
one-seventh recover. It has been remarked that women are more readily cured 
than men. 

Chapter IX. Treatment of Insanity. — M. Broussais after adverting to the 
cruel and oftentimes absurd modes formerly pursued in the treatment of men- 
tal diseases, gives a sketch of that proposed by Pinel; this he thinks is too inac- 
tive, although he considers it as far superior to that of his predecessors. He 
then gives what he conceives as the most proper and efficient. This is of 
course founded on the doctrine of insanity being an irritation; this irritation is 
to be combated by two classes of remedies, the sedatives and the counter-irri- 
tants or revulsives, at the same time paying attention to the removal of the 
causes which have induced the appearance of the disease. This is the most in- 
structive chapter in the work; it abounds in sound practical precepts, and will 
amply repay an attentive perusal. 

The work terminates with a supplement in which M. Broussais again plunges 
into the depths of metaphysics; in this we shall not attempt to follow him, as we 
are fearful that we should not be able to give such a condensed view of his ar- 
guments as would be satisfactory. We do not wish it to be believed from what 
we said at the commencement of this notice, that we would wish to decry the 
importance of physiology as elucidating the operations of the human mind; on 
the contrary, we are fully persuaded that in whatever manner we attempt to 
view mental diseases, that the physical nature of man must necessarily attract 
great attention. To understand the human body, the laws by which it is go- 
verned, and its diseases, every circumstance must be taken into view, taking all 
our facts from nature; and excluding opinions however plausible, or supported 
by authority, if unsubstantiated by reason and observation. On this account we 
cannot, with the information we as yet possess, admit that animal life and its 
attendant phenomena wholly depend on the irritability of organized parts, 
although we fully agree that it is a very general property of these parts. Not- 
withstanding the strong and confident manner in which M. Broussais denies the 
existence of the vital principle, we cannot yet be convinced that this attribute 
of animated nature is a non-entity. Its effects are obvious whilst life exists, and 
cease on death taking place. What the nature of this sacred flame may be, is a 
question that will in all probability never be solved by mortal man; it is not al» 
No. VII.— May, 1829. 24 



186 Bibliographical Notices. 

lotted to him to raise this last veil of nature's sanctuary. But if we are not 
permitted to taste the fruit of the tree of knowledge, we are invited to shelter 
ourselves beneath its widely spreading- branches, and are amply rewarded 
for our exertions in reaching it, by the multitude and beauty of the objects 
we discover on our way. Let us therefore be satisfied that some bound has 
been set to the aspiring- mind of man, with the fact that his researches have eluci- 
dated many of the mysteries of nature, forced her to submit in a great de- 
gree to his sway, and made her laws and operations minister to his wants and 
pleasures. 

R. E. G. 



XIX. Histoire Philosophique et Medicale des Hemorrhagies, de leurs Causes Es- 
sentielles, Immediates ou Prochaines, et des Mtthodes de traitement qu'il convient 
d'employer dans cette classe de Maladies. Par D. Latouh, Docteur en Medecine, 
Ancien Medecin de L'Hotel Dieu d'Orleans, &c. Tom. 2. Oct. pp. 1016. 
Paris, 1828. 

M. Latour professes himself an adherent of the ancient regime, and as such 
sets out in the voluminous work under the above title, with a protest against 
the leaders of the present French system, for having apparently conspired to 
banish the consideration of proximate causes from the study of medicine, as al- 
together hypothetical. Now, if the term proximate cause mean that derange- 
ment or lesion in a part or organ upon which the phenomena of disease 
necessarily depend, his accusations against the pathologists of the present day 
are surely unfounded, since their efforts are mainly directed to the explora- 
tion and demonstration of all such alterations and lesions. But should M. La- 
tour include something more than this in his notion of proximate or essential 
causes, we would beg leave to refer him to the example of the great Newton, 
who, we think, displayed his wisdom in nothing more than in limiting himself 
to the close observation of facts, without pretending to search into the proxi- 
mate or hidden principles upon which the laws of nature are founded. Are the 
primary elements of disease any more tangible than those of gravity or life ? 

In the prosecution of his subject, M. Latour appears to have made the most 
faithful research into the records of his profession, and to have culled nearly 
every thing worthy of attention from both ancient and modern writers. He 
treats in detail of every variety of haemorrhage, whether proceeding from solu- 
tion of continuity occasioned by external violence or by erosion, or occurring 
without any apparent breach of continuity. The progress of pathological ana- 
tomy has shown that hsemorrhagies occur more frequently under the last men- 
tioned circumstances than was formerly supposed, and that though most 
common from the mucous tissue lining the mouth, nose, eyes, lungs, intesti- 
nal canal, urethra, and uterus, they also frequently issue from the serous mem- 
brane forming the pleura, pericardium, peritoneum, tunica vaginalis, from 
the synovial membranes, and likewise into the cellular tissue, giving rise to 
sanguineous infiltrations into the muscles, brain, heart, lungs, and liver. The 
orifices through which the blood usually escapes where there is no solution of 
continuity, are the exhalents and secretory and excretory conduits. 

After an examination of the opinions held by the most eminent ancient and 



Bibliographical Notices. 187 

modern writers relative to the proximate causes of haemorrhagies, he sums up 
the evidence which, with one of his illustrations, we here translate. 

" According 1 to Bichat and Pinel, it is important to know that there are two 
modes in which the orifices dilate in haemorrhagies without solution of conti- 
nuity. In one the dilatation takes place in an active, and in the other in a passive 
manner. It appears to me that the term active haemorrhage expresses a complex 
idea, which includes 1st, the idea of the active dilatation of the orifices; 2d, the 
idea of an expulsive effort by the augmentation of the vital properties of the san- 
guineous vessels; 3d, the idea of an extraordinary moving principle, or 
augmentation of the vital properties of the sanguineous fluid itself. Now, may 
not these three conditions be found sometimes associated, sometimes separate, 
sometimes variously combined ?" 

"I believe that I have seen them united in a young man of athletic constitu- 
tion, with whom, during a nasal haemorrhage, every symptom announced a gene- 
ral elevation of the vital forces; the general fever, the violence of the fluxionary 
movement towards the head, the effervescence of the blood which issued in 
large drops; in fine, the abundance and nature of the haemorrhage which, 
triumphing over all the remedies used, and even plugging up, ultimately caus- 
ing the death of the patient in twenty-four hours." 

The following remarks relative to what M. Latour terms the hemorrhagic de- 
rivation, are curious if not important. It may, however, be first proper to ex- 
plain that by this term he appears to mean a determination of the blood to 
some particular part, as for example, towards an opening made in a blood-ves- 
sel, or the seat of a stimulating application. 

" Several modern observers have believed that the blood in its derivation, did 
■not always follow the laws of the Harveian circulation. An author of the mid- 
dle of the last century observed that if a vein was opened in a living animal, the 
blood flowed and directed itself towards the puncture, contrary to its usual 
course. The edges of the orifice then became red and swelled, a circumstance 
which ought to lead to much caution in the use of blood-letting as a derivative; 
since if the blood be taken from near the spot which is the seat of inflammation, 
the effect would certainly be to bring more blood into the part. Mercatus has 
shown the inconvenience of this practice in falls and blows, and proved that in 
such cases the bleeding should be made from a distant and almost opposite 
part" 

We doubt whether many of our readers will sustain such a practice, how- 
ever plausible the theory. 

Our author dwells much upon another determination of the blood, to the con- 
sideration of which he attaches the greatest importance, namely, the fluxionary 
haemorrhagic movement. This differs both from the ordinary motion of the cir- 
culation, and from that which constitutes the haemorrhagic derivation. He illus- 
trates it in the following manner: — 

"If an incision be made with a lancet in some part of the capillary system, 
only a few drops of blood will be found to escape, because in this case there are 
no other movements than the one which is proper and ordinary to the circula- 
tion, and that which we have already said constitutes the haemorrhagic deriva- 
tion. But if the same operation be performed by a leech, the puncture will be- 
come irritable and painful, followed by an afflux of blood from all the neigh- 



1S8 Bibliographical Notices. 

bouring parts, that is to say, a hemorrhagic jiuxionary movement. Should all the 
blood thus drawn escape through the puncture made by the leech, there will 
be a hemorrhagic fluxionary movement without hemorrhagic congestion. But, 
if on the contrary the orifice is insufficient to permit the escape of all the blood, 
it will accumulate in the vicinity, distend the vessels, become red, swell, ren- 
der the part it occupies painful, and there will be congestion and hsemorrhagic 
fluxionary movement." 

This movement M. Latour considers generally only a local excitement of the 
sanguineous system, a direction of the circulation towards a certain point. Occa- 
sionally, however, it is to be considered in some degree as general. 

When, in order to restrain or check the violence of the fluxionary move- 
ment, general blood-letting is resorted to, as in cases of plethora, our author 
thinks with Mauriceau, that the intention may be fulfilled with the greatest ad- 
vantage, and without producing debility, by closing the orifice at intervals dur- 
ing the operation. He mentions a case where this plan was attended with sin- 
gular success in curing a quinsey in a young man who could not bear the loss 
of much blood. The operation was so managed that the blood escaped from 
the vein drop by drop for six hours, whieh ultimately produced the desired re- 
vulsion. 

He thinks leeching and cupping highly useful revulsives, especially as they 
are less debilitating than general blood-letting. Leeches establish a fluxionary 
movement which continues a long time after their application, whilst cups are 
still more efficient from the pain and irritation which they excite. 

Various irritants are likewise resorted to for the purpose of counterbalancing 
the primary fluxionary movement. Of these there are applied externally, blis- 
ters, sinapisms, baths, issues, frictions, &c. — internally, vomits, purgatives, su- 
dorifics, diuretics, Sec. 

Various opinions have been held relative to the best situation for the applica- 
tion of revulsives in hsemorrhagies. Our author holds that they should be ap- 
plied near the seat of the fluxionary movement, unless there be particular or- 
gans having a stronger sympathetic connexion. This seems to us much at va- 
riance with other conclusions drawn by him. It is not, however, the first incon- 
sistency of which he is apparently guilty. 

Upon the subject of the internal use of astringents so commonly resorted to 
in this class of diseases, M. Latour quotes the following opinions, derived from 
the school of Montpellier; namely, that they are generally injurious when there 
exists strong excitement of the sanguineous system, and can only be exhibited with 
safety when the strength of the patient begins to be exhausted. Given in small 
doses for the purpose of checking local congestionary determination, they are 
particularly injurious, by producing a general constriction, transcending that 
which is local; whilst, administered in large doses, they may act as pertur- 
bateurs. When, however, the fluxionary movement has become feeble, the as- 
tringent compression acting primarily upon the first passages, is promptly 
transmitted to other parts by virtue of a sympathetic communication. 

If no circumstances exist to countermand their employment, such as plethora, 
&c. our author approves of emetics, but thinks that vomiting might be highly 
injurious in case the fluxionary movement was general and in full force. Too 
much debility, on the contrary, contraindicates their employment. The other 



Bibliographical Notices, 189 

evacuating- medicines, such as purgatives, diuretics, and sudorifics, ought, he 
says, to be regarded as excellent revulsives, in consequence of their acting upon 
different organs than those from which the blood runs. When the fluxionary 
movement is local, the stronger kinds may be chosen; but as soon as this be- 
comes general, those which increase the action and produce a general commo- 
tion of the system, should be avoided. Extreme weakness ought always to con- 
traindicate the employment of evacuants. As purgatives increase the fluxionary 
movement towards the uterus, they are not proper in hemorrhages of this organ. 

A large portion of our author's second volume is occupied with the consider- 
ation of hemorrhagic fever, a term he applies in a general sense to all cases 
where fever exists either as a cause or product of hemorrhage. This fever he 
views under four principal heads; 1st. As existing previous to the hemorrhage; 
2d. As following it in a longer or shorter time; 3. As existing at the same time; 
4. In the character of an adynamic, ataxic, or slow hectic, consequent upon a 
profuse hemorrhage. The general characters of this fever are explained in the 
following extract: — 

" Several authors have in vain attempted to fix the form and duration of the 
hemorrhagic fever. Sometimes it is scarcely perceptible; sometimes it rises to 
intensity; at others it is continued, or presents exacerbations and remissions. 
Its duration is not less variable than its form, &c." We subjoin a few words re- 
lative to its treatment. When the fever runs high, it may be diminished by 
blood-letting, diluting drinks, nitre, and perfect repose. With some precautions 
bleeding is to be regulated by the same rules given under the head of fluxion- 
ary movement. To show that a vein should not be opened during the formation 
of a hemorrhagic crisis, our author cites a case from Hoffman, wherein bleed- 
ing under such circumstances proved fatal. 

M. Latour considers nitre the refrigerant par excellance, possessing the pro- 
perty of diminishing the febrile and fluxionary movements. 

Under the head of haemorrhagic congestion, he approaches so near upon the 
territories of inflammation, that we doubt whether upon close investigation he 
would be able to sustain his title to the ground. He says a good deal upon the 
subject of hemorrhagies originating from a sympathetic influence producing de- 
rivation from one organ to some other organ or part, as from the uterus in sup- 
pression of the menses, to the liver, spleen, lungs, nose, &c. 

Under the title of la gdne de la circulation, he treats of hemorrhagies depend- 
ing upon obstruction of the blood in its ordinary course, as for example, from 
some impediment in the spleen, liver, pancreas, lungs, uterus, ovaries, &c. oc- 
casioned by various causes, such as scirrhus, compression, malconformation, &c. 
The work concludes with various considerations relative to atony of the solids, 
and alterations in the qualities of the blood. G. E. 



XX. Du Degrt de Competence des Midicins dans les Questions Judiciaires relative 
aux Alienations Meniales, et des Theories Physiologiques sur la Monomonie, 
Par Elias Regnatjlt, Paris, 1828. pp. 207. 8vo. 

There are few subjects appertaining to the medical art, which have been more 
completely overlooked in this country, than those connecting it with the ad- 



1 90 Bibliographical Notices. 

ministration of justice. This is the more remarkable, since daily experience 
most clearly demonstrates how much the fame and usefulness of a practitioner 
depends on a thorough and intimate acquaintance with subjects, which, although 
not called into play in the treatment of disease or alleviation of suffering-, are 
highly necessary parts of his professional acquirements. This neglect has and 
will continue a reproach to physicians, so long as they rely on the resources of 
a general knowledge of the principles of medicine as fitting them to examine 
and decide on questions of judicial inquiry. The extraordinary contradictions and 
discrepancies which so generally mark the testimony of medical men, when call- 
ed on in the capacity of witnesses, are unfortunately but too well known to need 
comment; we may, indeed, safely affirm that there are but few instances in which 
physicians have been examined before a court of justice that have not tended 
to throw obloquy and discredit on the profession generally, and, in a majority 
of cases, to weaken that personal respect and reliance on their skill which had 
been previously entertained. 

This is peculiarly the case in questions of insanity, for when a physician is 
summoned as a witness on such occasions, he is examined not only as to his 
knowledge of a particular occurrence, but his opinion on the results, conse- 
quences, or causes of that occurrence is also required, and on this opinion, 
whether false or well-founded, proper or erroneous, much may depend. It is 
this liability to be called on to elucidate or substantiate theories, as well as to 
testify to facts, that renders the situation of medical witnesses so embarrassing 
and irksome, and creates a strong disinclination in most members of the pro- 
fession to discharge this important part of their duties towards society. But, 
whatever may be our feelings or sentiments as regards the office, it is one we 
are not only obligated to discharge, but it is also one from which there is no 
means of evasion; hence the absolute necessity of being fully prepared to ex- 
plain every fact and opinion having any bearing on or connexion with our pro- 
fessional pursuits. It has, we are well aware, been often asserted, and, we must 
confess, with some degree of apparent plausibility, that any physician who is 
well versed in the general principles of his art must be perfectly competent to 
fulfil these duties, but no opinion is more erroneous, and is more fully disproved 
by actual experience. A perusal of any report of trials in which physicians 
have acted as witnesses, will serve to convince the most prejudiced that how- 
ever able and skilful medical men may be in the daily routine of their profes- 
sional duties, they are but too often wofully deficient on those points which so 
often become the subjects of judicial investigation. 

M. Regnault, the author of the work, the title of which stands at the head of 
this article, is an advocate in the royal court of justice in Paris, and of course 
presents a different view of the subject from what has hitherto been given. From 
actual experience and observation, he is of opinion that the consulting of physi- 
cians in cases of alleged insanity, arises more from respect and long-established 
custom, than from any peculiar information or light they can throw on the subject. 
Indeed, he goes so far as to re-echo the assertion of Dr. Coste, that any man of clear 
intellect and judgment is as fully competent to decide on questions of this nature 
as Pinel or Esquirol, from having the advantage of being wholly free from a theo- 
retical bias. Although far from allowing the truth of this general attack on the 



Bibliographical Notices. 191 

knowledge and capacity of our profession, as witnesses in cases of insanity, we 
are obliged to concede that there is much truth in the allegation, for although 
much has been accomplished within the last few years in the elucidation and 
discrimination of mental diseases, they still remain involved in great obscurity. 
We now allude particularly to those cases where the alienation of mind is oc- 
cult, or is undistinguishable by the world generally, and it is only in such states 
that medical evidence is absolutely necessary. When it is apparent and glaring, 
there is little use in summoning a medical man, as every bystander is as fully 
capable *of deciding as himself. 

The observations of M. Regnault are strongly corroborated by the result of a 
late trial in London, on a commission of lunacy issued against a gentleman of 
seventy-seven. In this case a great number of medical witnesses were examin- 
ed, and, as usual, contradicted each other in the most direct and positive manner. 
Many of these witnesses were gentlemen who had been attached for many 
years to lunatic asylums and hospitals, presenting them with the amplest op- 
portunities of becoming acquainted with alienation of mind in all its forms, yet 
with these advantages the report of the trial presents a tissue of glaring absur- 
dities and discrepancies of opinion. Even Dr. Haslam, who has written so 
much on the subject of derangement, delivered the most extraordinary and con- 
tradictory testimony, aftfer asserting that the person was non compos, yet goes on 
to say "that if he were to commit murder he, (Dr. H. ) would find him guilty, and 
see him hung afterwards." But there were other facts which were developed, 
which we are afraid would be equally the case in this country. Thus, when 
many of the medical witnesses were asked if they knew what were the senti- 
ments of the most eminent writers, both ancient and modern, on the subject of 
insanity, they were obliged to declare their total ignorance of them. 

The opinions of medical authors on the nature and seat of insanity are at great 
variance with each other, and are summed up with great ability by M. Regnault. 
We shall attempt to give his analysis in as few words as possible. The hu- 
morists, as Galen, Boerhaave, Van Swieten; 8cc. and the animists, as Stahl and 
Van Helmont, have each established systems founded on their peculiar doctrines. 
Hence, at one time the bile, blood, and other fluids enacted an important part, 
whilst at another every thing was attributed to the influence of the archaeus, to 
the vital principle or animal spirits. Crichton considers insanity as a disease of 
the nervous fluid, whilst Pinel is of opinion that the primitive seat of alienation 
of mind is in the stomach and intestines, whence the irritation is transmitted 
to the sensorium. Esquirol observes, " Sometimes the extremities of the 
nervous system, sometimes the digestive canal, at others the liver and its 
dependancies are the seat of the disease." Fodere thinks that the vital princi- 
ple is the seat of insanity. Georget, on adopting the ideas of Gall, is of opinion 
that insanity is a peculiar affection of the brain, whilst at the same time he agrees 
that the organic alteration which occasions it is unknown to us; and, finally, the 
two latest writers on the subject, Bayle and Calmeil, differ very widely in their 
ideas as to the parts of the brain which become affected, but our limits will not 
permit us to follow M. Regnault in his view of the theories of different authors 
as regards some of the species of insanity. 

The subject of monomania has attracted great attention in France, within the 
last few years, and has been ably discussed by Esquirol and others, particularly 



192 Bibliographical Notices. 

that species of it termed monomanie homicide, " or a partial delirium character- 
ized by a greater or less impulse to the commission of murder." This variety 
appears to have been very common in the above-mentioned country, as the re- 
cords of the public tribunals are filled with details of trials for murder, in which 
the insanity of the accused was allowed as a mitigation of the offence. After dis- 
cussing the subject at some length, M. Regnault comes to the following con- 
clusions. " That physicians have improperly given the name of monomania to 
excesses of the passions. Monomania homicide ought not to be admitted as a 
plea of justification. Even if this affection really existed, it should not b*e allow- 
ed to have any influence on the verdict; for either insanity consists in the pre- 
dominance of several erroneous ideas, when it is not monomania, or it is con- 
stituted of a single predominant idea, existing previous to the commission of 
the murder, hence it is not monomania homicide, for the idea of the murder is 
only the consequence of the erroneous pre-existing idea, and that of the destruc- 
tion of a fellow being does not constitute the disease, it is but a symptom and con- 
sequence of it." 

In fact, M. Regnault is decidedly of opinion that the partial delirium known 
under the name of monomania, should not be allowed as a justification or excuse 
for the commission of a criminal act. His arguments are certainly ingenious and 
well arranged, but they fail in convincing us of the truth of his doctrine; we 
cannot agree with him that it is a false humanity to spare the life of a murderer 
on the plea of insanity, or that it will have the effect of making murders more 
numerous. R. E. G. 



XXI. Myology, Illustrated by Plates, in four parts. Part I. Muscles of the Anterior 
part of the Thigh, Leg, and Foot. Part II. Muscles of the Anterior and Pos- 
terior part of the Arm and Hand. Part III. Muscles of the Abdomen and Back. 
Part IV. Muscles of the Face and Eye, Anterior and Posterior part of the Neck, 
with the Muscles of the Perineum, completing the whole of the muscles of the 
Human Body. By Edward William Tuson, House Surgeon to the Middle- 
sex Hospital. London, 1825, folio, pp. 8. Plates. 

A Supplement to Myology, containing the Arteries, Veins, Nerves, and Lymphatics 
of the Human Body, the Abdominal and Thoracic Viscera, the Ear and Eye, 
the Brain, and the Gravid Uterus, with the Foetal Circulation. By Edward 
William Tuson, Lecturer on Anatomy and Physiology, Member of the 
Royal College of Surgeons in London, &c. 8cc. London, 1828, folio, pp. 9. 
Plates. 

These are large and showy works, having plates of a " peculiar construc- 
tion," made up of numerous layers, exhibiting the figures and relations of parts 
as accurately as can be done by drawings on paper Thus, each plate is de- 
composable, and by raising the external figure we see the parts lying beneath ■, 
by lifting the second, we see a third, and so on successively to the bone. The 
figures are generally accurate and are done from drawings on stone. The co- 
louring of the work is sufficiently well done to be of assistance to the student 
in discriminating the different textures and organs, though it can lay small 
claim to notice us an imitation of nature. Some of the plates, especially the 
more complex, are not equal in execution to those of the muscles: but allow- 



Bibliographical Notices. 193 

ingfor the difficulties of the enterprise, the whole work is creditable to its 
author, who appears to be a zealous and devoted student of his profession. 

The importance of such a set of plates to surgeons or physicians having- but 
few opportunities of renewing their anatomical researches, is sufficiently .obvi- 
ous. As a remembrancer of the succession and relation to parts upon which 
operations are to be performed, or as affording the means of forming a judg- 
ment of the displacements, &c. caused by luxations? their utility is equally con- 
spicuous. To students who have attended lectures, or witnessed dissections, 
these plates may afford much assistance in acquiring correct general ideas of 
the muscles, &c. 

Such plates are applicable to another purpose, which we believe might be 
made of great benefit to the interests of science and humanity. Judiciously 
used, they would enable physicians to give their verbal description, and by 
teaching them something of anatomy, awaken the minds of the public to a pro- 
per sense of its importance and to the necessity of giving the study every pro- 
per encouragement. It is now thoroughly proved by experience that the system 
of making a mystery of anatomy and anatomical researches is totally wrong, and 
that the more the public mind is enlightened on the subject, the fewer are the 
obstacles raised to the prosecution of the science. To gentlemen who have 
libraries, and especially to such as are devoted to the liberal professions, we 
would take the liberty of recommending them to obtain a copy of Mr. Tuson's 
fine representations of the human structure. 

Mr. Tuson speaks as if he might hereafter attempt some other parts of ana- 
tomy in the same style. We heartily wish him success in so laudable and use- 
ful an enterprise. 

The two volumes may be procured of Mr. J. Dobson, No. 108, Chesnut street, 
for the moderate price of fifty dollars. 

J. D. G. 



XXII. Gemeinsame deutsche Zcltschrift fur Geburtskunde, von einem Vereine von 
Geburtshelfern. Herausgegeben durch D. W. H. Busch, L. Mende, und F. 
A. Ritgen. Band 3. Heft 2. Weimar, 1828. 

This general journal of midwifery is published in numbers containing from 
twelve to fifteen sheets, as the editors deem necessary; three numbers form a 
volume; the price of each number varies according to the amount of matter and 
the plates necessary for its elucidation. No time is specified for the appearance 
of the journal, which is issued as soon as sufficient materials are collected. The 
number before us contains thirteen and a half printed sheets, with three plates, 
and the price is one rix dollar eighteen groschen. Three volumes have already 
been published. 

The contents of this number are as follows: — 1st, A long and interesting pa- 
per by Dr. F. A. Ritgen, on excessive distention of the abdomen in pregnancy; 
2d, Description of a pair of obstetric forceps, invented by Dr. L. Mende; 3d, 
A case of Cxsarian section rendered necessary by malacosteon, by Dr. Von 
Busch; 4th, On the use of Ergot, by Dr. Glasor; 5th, View of the cases oc- 
curring in the Lying-in Hospital at Cologne during the year 1826, by Dr. Mer- 
rem; 6th, Account of the cases in the Lying-in Establishment of Mauburg, from 
No. VII.— May, 1829. 25 



194 Bibliographical Notices. 

the 1st of May, 1823, to the 30th of April, 1824; and from the 1st of May, 1824, 
to the 30th of April, 1825, by Dr. Busch. These papers are followed by an am- 
ple survey of the literature of obstetrics, during the period elapsed since the 
appearance of the preceding number, and a history of the institution in Fulda 
for the instruction of mid wives, by Dr. Adelmann. 

The lateness of the period at which this journal came to hand renders it im- 
possible to follow our usual practice of giving- extracts from the papers. To 
remedy this defect we may present in our next periscope such summaries of 
the most interesting articles as will be useful to our readers. J. D. G. 

XXIII. Transactions of the Medical Society of the State of New York, for the year 
1829. With the Annual Address. By T. Romeyst Beck, M. D. President of 
the Society. Albany, 1829, pp. 20, 8vo. 

The principal subjects brought before the society at its annual meeting this 
year, were, the establishment of a state vaccine institution — the pecuniary em- 
barrassments of the College of Physicians and Surgeons of the State of New 
York — Intemperance — the evils arising from the want of some regulation to go- 
vern the vending and preparing medicines by ignorant and careless apotheca- 
ries — and the prevention of the passage of a law providing for the licensing of 
"steam doctors." 

The following prize questions were proposed for the year 1830. " 1st. The 
history, preparation, and medical uses of iodine." "2d. The nature, symptoms, 
causes, and treatment of delirium tremens, illustrated by cases." A premium 
of fifty dollars is offered for the best dissertation on each of the above subjects. 
The dissertations must be forwarded to Albany on or before the 1st of Decem- 
ber next, accompanied with a sealed paper containing the name of the author, 
and endorsed, as well as the dissertation, with the same motto. 

Drs. John B. Beck and James M*Naughton were elected delegates to the 
Medical Convention at Washington, in 1830, to revise the Pharmacopoeia. 

The following officers were elected for the ensuing year: Dr. T. Romeyn 
Beck, President; Dr. Henry Mitchell, Vice President; Dr. Joel A. Wing, Secre- 
tary; Dr. Jonathan Eights, Treasurer. 

The annual oration, which was delivered by the President, Dr. T. Romeyn 
Beck, is a very interesting one. The subject of it, is the improvement of medi- 
cine, and the first illustration given "is the distrust which is obtaining against 
general theories." We look upon this distrust, more particularly as a proof, of the 
imperfection of our science, and should have first cited as an evidence of its 
improvement, a fact which the author has entirely omitted, viz. a distrust 
which is really obtaining against medical facts and medical experience. 
It was truly said by Cullen, " that there are more false facts in medicine than 
false theories." We yield our full assent however to the following observa- 
tions, "There is no theory," says Dr. B. " ever yet promulgated, which is not 
based on some portion of positive truth. Indeed it could hardly have been other- 
wise. The founders were men of vigorous intellect and of keen observation. 
They drew from their own stores, and were only wanting in that universality of 
knowledge which is essential to the formation of a perfect system — they seized 
on some prominent phenomenon, and after examining it with skill and acute- 



Bibliographical Notices. ] 95 

ness, made it the ground-work of their superstructure. In the devotion so natu- 
ral towards a favourite opinion, other facts no less striking-, were either unheed- 
ed, or diminished in value to their mental view. Thus the basis was frequently 
narrow and contracted, but not, as some are fond of asserting", imaginary." 

Dr. Beck appears not to be a convert to physiological medicine, but as he 
offers no specific objections to it, we cannot attempt its defence. He renders 
full praise to Bichat for his labours, in which we cordially join; as also with his 
observations on the powerful and often deleterious effects of vegetable remedies. 
We cannot, however, unite with him in his extravagant eulogium on mercury. 

" As to mercury," he remarks, " I will only say, thatif there be a single drug, 
that in human hands has proved a most distinguished curative means, it is this. 
That its effects may be occasionally uncertain or injurious, is only to repeat that 
there are peculiarities of constitution for which the wisest cannot be prepared — 
or that there is a malignancy in some diseases which no human effort can coun- 
teract. But who will deny its positive utility? Look at the thousands whom, 
not only in tropical climates, but in our own country, it has saved from that fell 
destroyer of our race — fever. Look at the numerous inflammations it has 
checked or dissipated. Look at the tens of thousands whom it has saved from 
the consequences of vice." 

Although in the habit of prescribing it almost daily, estimating it as one of our 
most valuable medicines, and free to confess that if deprived of it, we should 
often be at a loss for a substitute, yet so fully convinced are we of the injurious 
effects that have been produced by its indiscriminate and improper administra- 
tion, that we are not satisfied whether it would not have been better for the 
human race if this preparation had never been discovered. If many lives have 
been prolonged by its judicious administration, not fewer have been destroyed, 
or their existence rendered a misery, by its mal-administration. 



XXIV. Jin Epitome of the Physiology, General JLnatomy, and Pathology of Bi- 
chat. By Thomas Hebtdebso^, M. D. Professor of the Theory and Practice of 
Medicine in the Columbian College, Washington City. Philadelphia, 1829, 
pp. 326, 8vo. 

The works of Bichat have been said, by one of our colleagues, with his usual 
felicity of expression, to be " arevelation in medicine." Their merit is, however, 
so generally admitted, and we have already so often expressed our opinions on 
the subject, that it is unnecessary here to pronounce their eulogy. They con- 
stitute the only basis of sound medical principles, and the student should com- 
mence his studies by making himself familiar with them. They are, however, 
so voluminous, that few students will devote to their perusal the time necessary 
for that purpose. Professor Henderson has attempted to remove this difficulty, and 
has prepared an epitome of all the writings of Bichat, and by selecting only the 
more important principles, and omitting many of the illustrations, he has been 
able to condense them into a small volume. This work, if it will not supersede 
the necessity of referring to the original, will nevertheless be of great advan- 
tage to the student; it will enable him to acquire in a short period, a knowledge 
of the fundamental principles of general anatomy, will inspire him with a fond- 
ness for the subject, which will induce him hereafter to consult the original. 



196 Bibliographical Notices. 

and it will enable country practitioners, who are not familiar with Bichat, and 
who are unwilling now to return to the study of the rudiments of their profes- 
sion, at least to teach them to their pupils. 



XXV. A System of Dental Surgery. In three parts. Part I. Dental Surgery as 
a Science. — II. Operative Dental Surgery. — III. Pharmacy Connected with 
Dental Surgery. By Samuel Sheldon Fitch, M. D. Surgeon Dentist. New 
York, 1829, pp. 568. 8vo. With 3 plates. 

A complete system of Dental Surgery has long been desiderated. In this 
country especially, where, except in a few of our large cities, the medical prac- 
titioner is compelled also to practice dentistry, the want of such a work has 
been much felt. "We have, it is true, some excellent tracts on several of the 
affections of the teeth, but few attempts ever have been made at furnishing a 
complete monograph of the diseases of these organs, and their treatment. The 
best is perhaps that of Fox, but it is already a quarter of a century since it ap- 
peared, and it is of course in some degree antiquated; moreover it is too costly 
to be accessible to the profession generally. The work of Dr. Fitch does not 
entirely supply the desideratum, nevertheless it will be useful. It is principally 
a compilation, but the selections appear to have been made with judgment, and 
display great industry, as a vast number of works having been consulted, and 
are quoted: it is modestly written, and contains a greater amount of informa- 
tion on the subject of which it treats, than is to be found in any other single 
work that we have met with. 



XXVI. Description of the Distinct, Confluent, and Inoculated Small-Pox, Vario- 
loid Disease, Cow-Pox, and Chicken-Pox. Illustrated by 13 Coloured Plates. 
By John D. Fishes, M. D. Boston, Wells and Lilly, 1829. pp. 73, folio. 

The paintings from which the plates* in this volume are engraved, were made 
at the hospitals of Paris, during the years 1825 and 1826, a period at which 
the variolous disease prevailed epidemically in that city. They were executed 
by a French artist, under Dr. Fisher's immediate direction, and were all begun 
and finished at the bedside of the patients from whom they were taken. The 
eruptions are exhibited in their different states of development, so that the ob- 
server may not fail, in some stage of their progress, to identify them in the living 
subject with their representations in the plates. 

The text contains a description of the plates and of the diseases represented 
in them; and to facilitate the diagnosis as much as possible, a comparison is in- 
stituted between the symptoms and characters of the small-pox and varioloid, 
small-pox and chicken-pox, and cow-pox and inoculated small-pox. 

The profession are under obligations to Dr. Fisher for this work, and we 
trust he will be remunerated for the expense and labour it must have cost him. 
It i3 splendidly got up, and the cost, comparatively, is very moderate. 

* Except the last, which contains representations of the chicken-pox, and the perfect and imperfect 
cow-pox in their different stages. 



( 197 ) 



QUARTERLY PERISCOPE. 



FOREIGN INTELLIGENCE. 



ANATOMY. 

1. Case in which the Uterus was wanting. — "Dr. Breschet relates that last 
February a young- woman, with fistula in ano, and who, from examination, ap- 
peared to have no uterus, applied to M. Dupuytrenfor admission into the Hotel 
Dieu. She had never had the menses, yet she always experienced the symp- 
toms which precede their periodical return. The pelvis was rather narrow, but 
the breasts and the external parts of generation were well developed, and her 
general appearance quite feminine. The vagina terminated at about an inch 
from its orifice, in a cul-de-sac, smooth and circular, with no indications of a 
uterus. The rectum was explored, but it led to no discovery. 

" This female had been living several years in concubinage, and was to be 
married on her recovery from the fistula. 

" The operation was performed by M. Dupuytren on the 28th February last, 
and she died of acute hepatitis on the 15th of the following March. 

- " The body was most carefully examined. The pleura, lungs, and liver pre- 
sented various traces of inflammation; and the left kidney contained a fibrous 
cyst, full of a white and inodorous fluid. The clitoris and labia were well de- 
veloped; but M. Dupuytren thought the cavity which occupied the natural 
situation of the vagina was the effect only of the efforts at coition. Above and 
behind the bladder were seen what appeared to be the broad ligaments of the 
uterus, in which were discovered Eustachian tubes and ovaria of a large size. 
There was no matrix; but where the tubes joined, their diameter was slightly 
augmented; yet this part had no cavity, and did not in the least resemble the 
uterus." — London Medical and Physical Journal for November, 1828, from the 
Mepert. d'Anat. 

2. Anomalous distribution of the Vascular System in a New-born Child. By 
Professor Mende. — The subject of this case died immediately after birth, 
without any apparent cause. The vessels were injected, and on dissection it 
was observed that the umbilical vein, instead of dividing into two branches to 
traverse the liver, continued in a single trunk over the convex surface of the 
right lobe of this organ, to the right auricle of the heart where it terminated 
before and above the orifice of the inferior vena cava. The heart appeared 
pushed downwards by the insertion of this insulated vessel; its base was much 
inclined to the right and towards the sternum, and its position was of course 
more transverse than usual. A single umbilical artery arose from the aorta 
near its bifurcation, and passed over the left side of the bladder towards the 
umbilicus. No other anomaly was observed. — Archives Qineralet, Dec. 1828, 
from the Nova Acta Phys. Med. Acad. C. L. C. Nat. Cur. 1827. 

3. Singular Biceps Muscle. — Mr. C. M. Barnett states, in the London Mcdi- 



198 QUARTERLY PERISCOPE. 

cal Gazette, for December last, that he met with one instance in which, in the 
right arm, instead of there being a biceps muscle having two origins, there was 
simply a one-headed muscle arising from the coracoid process. No tendon could 
be found passing through the joint answering to the long head of the biceps, 
neither was there any appearance of a bicepital groove; the capsular ligament 
was, perhaps, thicker than ordinary. 

4. Recurrent Laryngeal Nerve. — It is generally stated by anatomists, that the 
distribution of the recurrent laryngeal nerve in the interior of the larynx is con- 
fined to the crico-arytenoideus posticus, crico-arytenoideus lateralis, and the 
thyro-arytenoideus muscles, and that none of its filaments extend to the other 
muscles of the larynx. Majendie seems to attach considerable interest to the 
limited distribution of this nerve, asserting that it is entirely restricted to the 
three muscles above mentioned. Cloquet has made a similar assertion; and Mr. 
Bell affirms that the termination of the recurrent nerve is exclusively confined 
to the muscles just named, and to the mucous membrane of the larynx. Mr. 
G. Raixet, in a communication in the London Medical Gazette, for December 
last, says, that in repeated dissections of the human larynx, he has uniformly 
been able to trace a branch to the arytenoideus transversus and the arytenoidei 
obliqui muscles. 

5. Proper Nerve of the Tensor Muscle of the Tympanum, or oj 'the Internal Muscle 
of the Maleus. — All anatomists have hitherto admitted that this muscle receives 
a nervous filament from the portio dura; but an attentive examination shows that 
it possesses a special nerve, furnished to it by a ganglion adhering to the inferior 
maxillary nerve. At the posterior and inferior part of the lower maxillary 
foramen, there is a rather large, irregular ganglion of a grayish red colour, 
strongly adhering to the inferior maxillary nerve; at the posterior and superior 
part of this ganglion arise two nervous filaments; the first, or the superior, al- 
ready known, contributes to form the nervous anastomosis of Jacobson; the 
other, or inferior filament, is appropriated to the tensor muscle of the mem- 
brana tympani; it passes backwards, and a little upwards, and after r.- course of 
three or four lines, gains the internal and posterior surface of this muscle. 
Where the latter becomes fleshy, this nerve divides into many small filaments 
which penetrate between the muscular fibres, and are there lost. This nerve 
corresponds to the internal part of the middle meningean artery, and to the 
superior part of the Eustachian tube, where the osseous portion of this canal 
unites with the cartilaginous; it is situated below the nervous filament that con- 
tributes to form the anastomosis of Jacobson, with which it is parallel, and above 
the spinous apophysis of the sphenoid bone. — Journal des Frogres, Vol. XII. 
from the Repert. d'Anai. Tom. VI. 



PHYSIOLOGY. 

6. Circulation, Absorption, and Secretion. — Some very interesting experi- 
ments in relation to these functions have lately been performed by M. E. Heh- 
ing, Professor in the Veterinary School at Stuttgard. They were made upon 
horses, and consisted in the transfusion into the current of the circulation of an 
innocent substance, easy to recognise by proper chemical tests. The blood 
was then drawn at determinate intervals from other parts of the body than those 
at which the introduction had been made, and upon examination and compari- 
son of the time occupied by the substance in passing from one vessel to another, 
an attempt was made to ascertain the precise deg-ree of velocity with which the 
blood circulates. The substance chosen was a solution of the hydro-protoferro- 
cyanate of potass, which, with the proper precautions, may be mixed with the 
blood in considerable quantity, without occasioning the least inconvenience. It 



Physiology. 199 

is, moreover, easily detected in either the solids or fluids of the body. As a 
test for this purpose, the sulphate of iron was found preferable to the sulphate 
of copper, or the hydrochlorate of iron. In order to procure an immediate blue 
precipitate with the first named agent, it was only necessary to add after it a 
little of the hydrochloric acid. By this means the hydrocyanated ferruret of 
potass could be distinctly detected, though diluted in twenty thousand times its 
volume of the serum of the blood. 

Previous to giving the results of the experiments performed by M. E. Hering, 
it may be well to observe that for the purpose of making the transfusion into a 
vein, he preferred a funnel to a syringe. The pipe of a large syringe furnished 
with a stop-cock, being adapted by means of a screw to a brass funnel, holding 
about two ounces, and the pipe inserted into the vein, the funnel was filled, the 
cock turned, and the liquid being thus allowed to pass into the vessel, care was 
taken to close the stop-cock in time to prevent the access of air. The follow- 
ing conclusions are furnished by our experimentalist: — 

1. A solution of hydrocyanated ferruret of potass introduced into the jugular 
vein of a horse, reaches that of the opposite side in from twenty to twenty-five 
seconds; the opposite external thoracic in from twenty-three to thirty seconds; 
the great saphena in twenty seconds; the external maxillary artery in from ten 
to twenty-five seconds; the metatarsal artery of the hind foot in from twenty to 
forty seconds. It is to be observed that all the vessels just mentioned are of the 
side opposite to that where the transfusion was made. If the liquid introduced 
into the veins is moved by the same impulse as the blood, that rapidity with 
which both are conveyed should be equal. The velocity of motion, however, 
does not appear to be increased in proportion to the increased rapidity of the 
pulse, since with different horses, the pulse in which varied from thirty-six to 
fifty-two, the results were similar. 

2. The hydrocyanated ferruret of potass is secreted by the serous membranes 
with great promptness, but in small quantity. The proportion of this secretion 
is regulated by the distance of the membranes from the heart, being greatest in 
those which are nearest. Thus it operates, first upon the internal surface of 
the pericardium, then successively upon the pleura, the peritoneum, and finally 
upon the articular capsules of the extremities. The cavities of the ventricles 
of the brain have only been examined in a few instances, in which no trace of 
the saline solution was found in them. In the other serous cavities, the time 
which this solution takes to manifest itself, varies between two and fifteen 
minutes after its introduction. And these were the last moments in which the 
animals showed signs of life. 

3. In the mucous membranes, the secretion does not take place so soon as in 
the serous. The foreign substance is, however, after some minutes, discerni- 
ble on their surfaces. The mucous membrane of the right half of the stomach 
secretes more promptly, and in larger quantity than that of the intestines, 
which in turn manifests it sooner than the mucous membrane of the lungs. The 
secretion takes place still more slowly upon the genito-urinary surfaces, as the 
portion of hydrocyanated ferruret of potass met with in the urinary passages, 
proves to be only the secretion of the kidneys. The mucous surfaces covered 
with a distinct epithelium, (the buccal cavities, the oesophagus, and right half 
of the stomach in the horse, for example, ) offer no trace of secretion from the 
saline solution transfused. 

4. It is difficult to recognise the foreign substance in the liver, spleen, thy- 
roid gland, and certain other glandular organs, in consequence of their darkish 
colour. Numerous observations seem to show that the salivary glands take a 
moderate part in its elimination. 

: 5. The kidneys, on the contrary, are employed very actively in this secre- 
tion. These organs have always in the course of a minute given decided mani- 
festations of the substance in some part of them. The passage of the urine into 
the bladder requiring some time, it follows that this organ does not exhibit 
traces of the hydrocyanate until after a longer interval. 



200 QUARTERLY PERISCOPE. 

6. The presence of the salt in the lungs is not quite so distinct as might be 
supposed. Is this attributable to the colour of the organ, or is the passage of 
the hydrocyanate too rapid to allow the vesicles to attach themselves to the 
sides of the vesicles, or be excreted by them? 

7. In some cases, the saline secretion adheres to the internal surface of the 
blood-vessels, where it is easily detected by the tests; more frequently, how- 
ever, it does not adhere at all. Occasionally it is found attached in some, and 
not in others, the cause of which difference is yet unknown. 

8. The time occupied by the solution in reaching the thoracic duct has varied 
from one to five minutes. It is not discovered so soon in the lymphatic gan- 
glions, from which circumstance our author supposes that there exists a direct 
communication between the arteries and lymphatic vessels. 

9. The foreign substance introduced into the blood is quickly separated from 
it by the secretory organs, and especially by the kidneys. In many cases the di- 
minution was already sensible in the course of a few minutes, and after five or 
six hours there remained no longer any trace, not even in the solids. 

10. Finally, it results from our author's experiments that the hydrocyanated 
ferruret of potass may be mingled with the blood without danger to animals. 
This is not, however, the case with the solution of indigo, and especially with 
the solution of the sulphate of iron, which last injected into the veins, coagu- 
lates the blood, and produces death in a short time. — Archives Generates, Sept 
1828, from the Zeitoch. fiir Physiol. Tom. III. 

7. Reunion of the Ends of Different Nerves. — M. Floured s, in a memoir in 
the JLnnales des Sciences Naturtlles, for February, 1828, states that after having 
repeated the experiments of Fontana, of Montana, of Cruickshanks, and of 
others, on the reunion of the divided extremities of the same nerve, sought to 
determine the effects resulting from the union of the ends of different nerves. 
He therefore placed them in contact, and there kept them. In every instance the 
reunion took place. In some of the cases, the return of the function was com- 
plete, in others it failed. In all, the transmission of irritations by the united 
nerves was perfect. 

8. Identical Active Molecules in Organic and Inorganic Bodies. — "While Mr. 
Brown was examining the pollen of various plants under the microscope, he ob- 
served distinct motion in the grains when immersed in water, consisting not 
only of a change in place, but of form also. Having observed this in the pollen 
of all the living plants he examined, he next tried to ascertain how long this 
property continued after the death of a plant, and found that plants dried, or 
immersed in spirit for a few days, and some even which had been dried for 
twenty years, and others not less than a century, still exhibited these active par- 
ticles. Whilst making the observation with the ovula or seeds of the equisetum, 
they were accidentally bruised, which very much increased the number of 
moving particles; and on bruising the floral leaves and other parts of mosses, 
they were also obtained. 

" With a view of ascertaining whether these active particles, obtained from 
such different parts of plants, were the supposed constituents or elementary 
molecules of organic bodies, different animal and vegetable tissues were examin- 
ed; whether living or dead, if bruised in water, they gave moving particles, 
identical with those of pollen. They were also found in products of organiza- 
tion, as gum resins, vegetable substances, and even pit-coal. The dust or soot 
deposited on bodies, especially in London, is entirely composed of them. 

" As the particles were found in fossil and silicified wood, they were next sought 
for in inorganic substances, and were at once obtained merely by bruising a 
small splinter of window-glass upon the stage of the microscope. They were 
obtained in succession from rocks of all ages, each of the constituents of granite, 
travertine, stalactites, lava, obsidian, pumice, volcanic-ashes, meteorites, man- 
ganese, nickel, plumbago, bismuth, antimony, arsenic, and in every mineral that 



Physiology. 201 

could be reduced to powder sufficiently fine to be temporarily suspended in 
Water. In many cases the particles seemed to aggregate into linear arrange- 
ments of fibrils, consisting of three or four, and these also had motion. 

" Wood, linen, paper, cotton, wool, silk, hair, and muscular fibre, being 
burnt, gave the molecules as evidently in motion as before combustion. 

"The form of these molecules appears to be spherical, but modifications of it 
occur in certain circumstances? the diameters of the particles are from one- 
fifteenth-thousand to the one-twenty -thousand of an inch. 

** The principal substances from which these molecules have not been ob- 
tained, are oil, resin, wax, and sulphur; such of the metals as could not be re- 
duced to the state of division necessary for their separation; and finally, bodies 
soluble in water. 

" All these observations were made under a simple microscope, and, indeed, 
with one and the same lens, the focal length of which is about one-thirty-second 
part of an inch." — Philosophical Magazine. 

9. Effects produced by a division of the Semicircular Canals of the Ear.-^l. 
Flourens recently presented to the Academy of Sciences of Paris, several me- 
moirs on this subject. 

From the ease with which the semicircular canals in birds may be operated 
on, M. Flourens performed his first experiments on them. In pigeons, which 
were the subjects chosen, two of the canals are vertical, the upper one of which 
is the larger, and obliquely directed from behind forward; the inferior is di- 
rected from before backward, crossing the third, which is horizontal. A divi- 
sion of the horizontal canal of both sides is immediately followed by a violent 
horizontal movement of the head, which is so rapid that the bird loses its ba- 
lance and rolls over, without power of recovering itself. A section of the ver- 
tical canal, whether superior or inferior of both sides, is followed by a violent 
vertical movement, whilst a section of all the canals produces a continued rota- 
tory action of the head. This division of the canals does not destroy life, but 
the effects produced continue during the remainder of the life of the bird. M. 
Flourens afterwards repeated the experiments on young rabbits with the same 
results, except that the movements were less violent. These morbid motions 
of the head, both in birds and quadrupeds, cease when the animal is quiet, 
but appear again the moment it attempts to move. It is, says M. F. an extra- 
ordinary fact, that parts so minute and delicate should act with so much energy 
on the system, and it is equally curious that parts which would appear to be 
specially appropriated to the purposes of hearing should exercise so marked 
an effect on the above described movements, and above all, that each of the 
parts should determine a motion in conformity with its own position. Thus a 
section of the horizontal canal produces a horizontal motion, whilst a vertical 
section is followed by a vertical motion. — Annates de Chimic, &c. Sept. 1828, 
and Archives G£n£rales> Nov. 1828. 

10. Researches on the Pollen of Plants and the ultimate Particles of Matter. — 
" The Academy of Sciences, at their meeting of Dec. 8, heard the report of 
MM. Cassina, Desfontaines, Mirbel, and De Blainville, on a memoir on Pollen 
and the Spermatic Granules of Animals, by M. Adolphe Brongniart. In a 
former memoir on the same subject, this gentleman had detailed some interest- 
ing and accurately analysed facts; on the theory contained in it the committee 
had not given any opinion, but had requested the writer to persevere in his ob- 
servations. In a subsequent paper, M. Raspail, an experienced microscopic 
observer, had combated the opinions of M. Brongniart, and endeavoured to de- 
monstrate that the granules contained in the grains of pollen, so far from being 
analogous to spermatic animalcules, are not even organized bodies. After ad- 
verting to these memoirs, M. Cassini noticed the opinions contained in a paper 
by the celebrated English botanist, Mr. Robert Brown. This gentleman thinks 
with M. Brongniart, that the granules of pollen are endued with a distinct and 

No. VII.— May, 1829. 26 



202 QUARTERLY PERISCOPE. 

independent motion; but on various theoretical points he differs from him. He 
has not only observed this motion in the granules of living plants, but has 
also perceived the same property of those of plants dried for a century, and 
preserved in spirits of wine, and in those of mosses and equisetums living* or 
dried; in the molecules obtained by triturating* in water the organic tissue of 
animals or vegetables living or dead; and in those obtained in the same manner 
from all sorts of inorganic substances, as glass, granite, &c. In short, he thinks 
that all the active molecules, organic or inorganic, are the same in nature, form, 
and size, and endued with the same properties; and not in the least different 
from those observed in pollen by M. Brongniart. 

" In the present memoir, which is principally devoted to the refutation of M. 
RaspaiPs objections, M. Brongniart cites, in support of his own mode of obser- 
vation, the curious fact that plants made to flower in winter, by means of shel- 
ter and artificial heat, have generally their grains of pollen filled with a mucila- 
ginous substance, devoid of regular and moving granules; and as these plants 
rarely fructify, he thence draws an inference favourable to his system. 

" Thus, then, the question discussed by M. Brongniart is now debated by 
three very skilful observers, and resolved in three different ways; for, whilst 
M. Brongniart admits, in the interior of grains of pollen, regularly organized cor- 
puscles, of a very peculiar nature, distinct from all other bodies, analogous to 
spermatic animalcules, and essentially destined to produce the embryo; M. 
Raspail sees nothing in these corpuscles but little resinous masses, shapeless, 
variable, and absolutely deprived of organization aud of life; and Mr. Brown, 
discarding at once the exclusive opinions of both, admits in all natural bodies, 
whether organic or inorganic, active molecules of the same form, size, and na- 
ture, and exhibiting a spontaneous motion as soon as they are disintegrated and 
plunged in fluid. 

" The committee, on the one hand, agreed with M. Brongniart and Mr. Brown, 
that the causes to which M. Raspail attributes the motion of the granules, exer- 
cise, in reality, no influence over them; and on the other, they coincided with 
Mr. Brown, that various inorganic bodies triturated in water, offer, if not always, 
at least sometimes, corpuscles whose size, form, and motion are nearly the 
same, under the microscope, with those of the granules of pollen. They also 
remarked, that the resemblance between the active molecules of Mr. Brown 
and the spermatic granules of M. Brongniart, furnishes strong presumptions 
against the hypothesis of the latter. They called the attention of botanists to 
the singular phenomenon of apparently spontaneous motion, and asked if it 
might not be attributed to mutual attraction and repulsion. Great difference 
was observed in the manifestations of this phenomenon; so much so, that under 
circumstances to all appearance alike, the granules of the same plant at one 
time exhibited a very perceptible motion, and at another perfect immobility. 

" * Such,' said M. Cassini, * are the external appearances. But must we, 
from these, necessarily conclude that the internal nature, and all the properties 
and functions, are absolutely the same, in bodies of so different origin? On 
this we have not had the temerity to decide; it can only be done after re- 
searches much more numerous and profound than we have been able to 
make.' " — The Magazine of Natural History, January, 1829, from Le Globe, 
December 13th, 1828. 

11. Successive Abolition of the Senses in four children of the same family. — " Dr. 
Stengel relates a curious circumstance which occurred in four children, born 
of strong and healthy parents, and who were affected successively with a ma- 
lady which manifested itself by the following symptoms: they all continued to 
thrive, both physically and mentally, until they attained their sixth year; but in 
their seventh year they all, one after the other, began to feel a particular weak- 
ness of the sight, which went on progressively increasing. The intellectual 
powers at the same time diminished; all those things which interested them be- 
fore, became now indifferent to them; they by degrees lost the use of speech. 



Physiology. 203 

In the ninth year vision became almost abolished, together with the use of the 
organs of sense. Cold and heat were hardly felt by them; they showed no in- 
clination for food; the sense of hearing was the last to leave them. From the 
ninth to the fourteenth year, epileptic affections came on, which continued to 
increase until the fifteenth year. At this period a species of mania declared 
itself. The eldest of these unfortunate children was a boy, who died in this 
state in his twenty-first year; the second was a girl, who died in her twentieth 
year; of the other two, who are still living, the one is a boy, aged seventeen 
years, and the other a girl, aged nine. The same symptoms are present in them, 
and is supposed that they will meet with the same end as the two first. The young- 
est child was sent, at four years of age, by its parents, to a great distance from 
home, with a hope of averting the melancholy catastrophe with which the 
others met; it continued to enjoy a good state of health until the sixth year, 
when the malady declared itself, which obliged the parents to send for the 
child home. All the therapeutic means employed in these cases proved quite 
unavailing, and had no influence whatever on the march of the disease. It is 
to be regretted that the bodies of the two who died were not submitted to an 
inspection." — Lond. Med. and Surg. Journ. Dec. 1828. 

12. Experiments on Cutaneous Absorption. By Dr. Westrumb. — Exp. I. Dr. 
Westrumb, having prepared a bath of the temperature of from 20° to 22° of 
Reaumur, containing a grain of hydrocyanate of potash, two grains of nitre, and 
some grains of musk, he placed his arms in it as high as the elbows, and kept- 
them there for three quarters of an hour. The bath having then been removed, 
the doors and windows were opened to change the air of the room; neverthe- 
less the odour of musk was manifest in the pulmonary exhalation of the experi- 
menter. He voided his urine immediately after the use of the bath, and at one 
hour, five hours, and thirteen hours, subsequently. The urine passed after the 
first hour exhaled a feeble odour of musk. Two specimens were taken of each 
portion of urine, one to be treated with tests of hydrocyanate of potash, the 
other for those of nitrate of potash. The presence of the prussiate was dis- 
tinctly visible in the first specimen, in the second there was no evidence of the 
existence of nitre. 

Exp. II. Was a repetition of the preceding experiment, the author enclosing 
his mouth and nose in a tube, one end of which passed out of the room, the 
whole so contrived that he breathed only the external air. After the experi- 
ment the pulmonary exhalation was impregnated with the odour of musk, but 
not so strongly as in the first experiment. This odour was not perceptible in 
the urine passed a short time after the experiment; but the hydrocyanate of 
iron was very perceptible in it; nitre could not be discovered in it. 

Exp. III. Was a repetition of the preceding experiment, and with the same 
results, but the experiment was not as carefully made. 

Exp. IV. This was a repetition of the two preceding experiments. Every 
care was taken, and the experimenter continued to respire by the tube for a 
long time after the experiment. The results were the same as before, only the 
odour of musk in the breath was less, and disappeared sooner. 

Exp. V. The tube being applied to the mouth and nose, the experimenter 
placed his arms as far as the elbows in a bath of a strong decoction of rhubarb; 
and had one of his legs rubbed with opodeldoc. He continued his arms in the 
bath an hour and a quarter. After the first quarter of an hour, the breath had 
a decided odour of camphor, which increased during the experiment, and was 
perceptible for six hours afterwards, but feebly. The urine passed a little while 
after the experiment, and that which was voided at the end of three hours, was 
of a reddish brown colour, when a solution of potash was added. This colour 
is attributable to the presence of rhubarb, for the same solution of potash 
mixed with urine passed before the experiment did not cause a similar change 
of colour. It cannot be said whether the camphor also passed into the urine, 



204 QUARTERLY PERISCOPE. 

though the odour of that collected immediately after the experiment was essen- 
tially different from that passed before the experiment. 

Exp. VI. Two vesicatories, each the size of a crown, having" been ap- 
plied to the legs of a healthy labourer, who had previously taken a bath to 
cleanse himself, the lymph was evacuated and cupping-glasses placed over the 
sores made by the blisters. The man then took a pediluvium of 20° Reaumur, 
containing hydrocyanate of potash, and the temperature of which was kept the 
same during an hour and a half. At the end of this period the vesicatories had 
discharged much, but two hours afterwards sufficient lymph had collected to 
enable a chemical analysis of it to be made. The small quantity of lymph col- 
lected having been diffused in distilled water, was treated with a solution of 
hydrochlorate of peroxide of iron; the liquid assumed a light bluish-green co- 
lour, a certain sign that it contained hydrocyanate of potash; and proving that 
this had been absorbed. The analysis of the portions of urine voided one hour, 
three hours, and five hours after the bath, confirmed also this fact. They 
changed, on the addition of a solution of salt of iron a beautiful blue colour, 
which was most intense in the portion passed three hours after the bath. The 
subject of the experiment would not consent to be bled, so that the blood could 
not be analysed. 

Exp. VII. A healthy and robust man continued an hour and forty-five minutes 
in a foot bath of 22° Reaumur, containing a strong solution of prussiate of pot- 
ash. The man voided his urine a little before the experiment, and also at two, 
seven and eleven hours after the bath; the urine passed the second hour on be- 
ing treated with the hydrochlorate of iron, assumed a fine blue colour, which 
showed itself more slightly in that passed at the seventh hour, and was scarcely 
perceptible in that passed at the eleventh hour. Some ounces of blood were 
obtained from this subject, by means of scarifications and cups to the thighs. 
The clots of blood being treated at first with a little nitric acid, were diffused 
in distilled water, and then submitted to the action of hydrochlorate of iron; it 
seemed to contain some slight but indistinct vestiges of hydrochlorate of potash. 

Exp. VIII. Four ounces of blood were taken from the arm of a person who 
had remained two hours in a foot bath, of from 20° to 22° Reaumur, in which 
had been put half an ounce of hydrocyanate of potash and two ounces of nitre. 
This blood contained evidently hydrocyanate of potash: as to the nitre, its pre- 
sence was not distinctly evident. The urine contained the hydrocyanate of 
potash. 

Exp. IX. A person introduced his arms as far as just above his elbows, into 
a bath containing a decoction of rhubarb; on withdrawing his arms from the 
bath at the end of an hour and a half, they were scarified, and cupping-glasses 
applied to them, by which means some blood was obtained. This blood being 
diffused in water, and treated with a solution of potash, assumed a deep brown 
colour. The same change of colour, indicating the presence of rhubarb, took 
place in the urine passed a little while after the use of the bath. 

Exp. X. After having opened, emptied and covered with cupping-glasses 
the vesications produced by blisters in a healthy man, his feet were placed for 
an hour in a bath composed of a saturated decoction of rhubarb. About a grain 
of lymph was collected in each cupping-glass; this lymph, as well as the urine, 
contained rhubarb. 

Exp. XI. The hind legs, and the greater part of the body of a dog, was 
shorn close, great care being taken not to injure the epidermis. The animal 
was afterwards held for half an hour in a bath of 20° Reaumur, to which had 
been added a saturated solution of hydrocyanate of potash. The dog having 
been strangled after the experiment, the blood of the vena cava, the urine of 
the bladder, the chyle of the thoracic duct were collected, and the lymphatic 
ganglions of the groin. The prussiate of potash showed itself very distinctly in 
the blood, but not in the chyle of the thoracic canal or in the inguinal glands. 
On dropping a solution of hydrochlorate of peroxide of iron on the adipose 
panicle, here and there a bluish-green colour was produced. 



Physiology. 205 

Exp. XII. Another dog was deprived of its hair in the same manner, and 
frictions made on the shorn parts, with a weak tincture of cantharides, until the 
skin assumed a red appearance; the animal was then immediately placed in a 
bath similar to that used in the preceding experiment, in which it was also kept 
half an hour. The presence of hydrochlorate of potash in the blood of the vena 
cava and in the small quantity of urine found in the bladder, was distinctly ob- 
served; it showed itself also in the chyle of the thoracic duct and in the lympha- 
tic glands of the groins, and the whole of the internal surface of the skin of the 
hind limbs and of the abdomen assumed a fine blue colour. 

Dr. Westrumb draws from these experiments as well as other facts, physio- 
logical, pathological and therapeutic, the following conclusions: — 

1st. The skin is endowed with an indeterminate faculty of absorption; it can 
admit and introduce into the circulation all sorts of substances, from the least to 
the highest degree of fluidity, provided they are soluble. 

2d. Some irritating substances which break or destroy the epidermis, are 
absorbed more quickly and in greater quantity than mild and non-irritating 
substances; first, because by destroying the epidermis, they remove a first ob- 
stacle which opposes itself to their easy absorption; secondarily, because that 
the irritation which they produce augments the activity of the absorbent veins; 
thirdly, finally, by overcoming the repulsive force of the lymphatic vessels, 
they incite these to take part in the absorption. 

3d. Mild articles which do not affect nor destroy the epidermis, are absorbed 
more quickly when the epidermis is injured or removed than when it is perfect; 
because, when the cuticle is removed, the contact of the foreign substances 
with the absorbents is immediate. 

4th. The vessels of the skin which possess the power of absorbing are some 
veins and absorbents. The first absorb always; the second do not take part in 
the absorption of heterogeneous substances here as in other parts of the body, 
but when their repulsive force has been overcome, or when some cause makes 
them deviate from their normal action. — Journal des Progres, Vol. XI. 

13. Poisoning of Plants by their own products. — M. Macaire read before the 
Physical Society of Geneva some interesting experiments on the effects pro- 
duced on vegetables by their own juices or products. The general results he 
obtained were, that the juices of plants which were capable of exercising a 
poisonous effect on other vegetables, were equally deleterious to the plant 
which furnished them, thus presenting another analogy between vegetable and 
animal life. These results can only be accounted for, says M. Macaire, on the 
following suppositions. — 1st. That the alteration which the vegetable extracts 
undergo by exposure to the action of the air renders them deleterious; or, 2d, 
by the separation of the poisonous and serous juices in different vessels in de- 
leterious plants. If this latter idea is admitted, the poisonous portion must be 
considered as a peculiar secretion, and not a fluid necessary to the life of the 
plant. — Annates de Chimie et de Physique, Sept. 1828. 

14. On the Effects of the Gastric Juice on the Stomach after Death, and on Ab- 
stinence. — Dr. Pommer has instituted a number of experiments on dogs, cats, 
and rabbits, to ascertain the correctness of the opinion of John Hunter, relative 
to the dissolving action of the gastric juice upon the stomach after death; and 
he has arrived at the following conclusions: — In animals the gastric and intesti- 
nal secretions neither soften nor dissolve the membranes of the stomach or in- 
testines; the secretion of these fluids is rather diminished than augmented dur- 
ing hunger; neither does the latter produce inflammation of the stomach; and 
death from inanition is the result of the general prostration of the vital forces, 
and not of inflammation of the stomach. Carnivorous animals support hunger 
better than herbivorous, and cats better than dogs; carnivorous animals who 
during abstinence, drink water lives longer than those deprived of drink. Rab- 
bits die often of inanition, although they have still some aliment remaining in 



206 QUARTERLY PERISCOPE. 

their stomach; these animals never drink; when driven by hunger, they take 
meat, they die in a short time afterwards, although they can digest this sub- 
stance, as is easily shown. In animals destroyed by inanition, the veins of the 
lower stomach are ordinarily gorged with blood. — Archives Gene" rales, Dec. 1828, 
from the Medic. Chirurg. Zeitung, 1828. No. 4. 

15. Menstruation at the age of nineteen months. — A case of this kind is re- 
lated in the third number of Meckel's Archiv.fur Anal, und Physiohgie for 1827. 
At birth this child was of an ordinary size; but after the first month she com- 
menced to grow rapidly, and at nine months it was of the usual size of a child 
of a year and a half old. About this time she passed from the vagina some drops 
of blood; at eleven months of age she had another and more abundant sangui- 
neous discharge; and at the same time the mammary gland began to be deve- 
loped, and hairs appeared on the mons veneris. At fourteen months she had a 
third, and at eighteen months a fourth sanguineous evacuation from the vagina. 
The whole physical development of the child is precocious; but her mental 
faculties are not greater than those of other children of her age; she appears to 
have no desire for sexual intercourse. 

16. Connexion between Monstrosity and Deficient Development of parts of the 
Nervous System. — Professor Tiedemanst has published, in the Zeitschrift fur 
Physiologic, an interesting series of observations on the connexion between the 
deficient development of the nervous system and of the extremities in monsters. 
He thinks "that there is a direct relation between the constitution of the nerv- 
ous system and the construction of the other parts of the body. With the ab- 
sence of any nerve there is connected the absence of the organ to which the 
nerve belongs, and with the imperfect formation of any part of the nervous sys- 
tem there is associated the imperfect development of the organ which it sup- 
plies. He is farther convinced, that in all monsters with excess of formation, 
whether it consists in single parts, oris extended to the whole body; or whether 
the doubling of parts is of the upper or under portion or to one side, the distri- 
butions of the nervous system correspond. The same takes place where two 
organs are blended into one. Professor Tiedemann, having assumed these as 
established facts, next proceeds to inquire whether the defective formation of the 
organs is the consequence of the want of the nerves; or whether the nerves are 
not formed because the organs are wanting; and conversely, whether the forma- 
tion of a part in excess is owing to excessive development of the nervous system; 
or whether the nervous system is in excess because there are supernumerary 
organs? As the result of a very ingenious and profound inquiry, he concludes 
that the nervous system, as the first existing apparatus, regulates the formation 
and development of the embryo, and determines the peculiar form and disposi- 
tion of the rest of the organs." — Ed. Med. and Surg. Journ. Jan. 1829. 

17. On the Powers which move the Blood in the Capillary System. By Dr. F. 
F. Retjss. — In Vol. I. p. 423, and Vol. III. p. 194, we laid before our readers a 
notice of the very interesting experiments of Dr. Dutrochet on the immediate 
agent of vital movements, from which experiments it would appear that this 
agent is galvanism or electricity. As connected with this subject, the following 
experiments and speculations of Dr. F. F. Reuss, published in 1821, in the 
Commentationes Soc. Physico-Medicse Mosquensis, II. ii. 327, and for a knowledge 
of which we are indebted to the Edinburgh Medical and Surgical Journal for 
July last, will be read with interest. Dr. II. relates, in a preliminary essay, se- 
veral experiments to prove a new property in galvanism, that of impelling wa- 
ter from the positive to the negative pole. 

" This impulse," says he, "towards the negative pole is better seen, when 
the water is contained between two parallel glass plates three or four lines 
apart from one another, and when the wires are immersed at right angles to the 
water, being made of gold or platinum, and covered with glass tubes sealed at 



Physiology. 207 

their extremities to the wires. It is convenient also to keep the wires steady 
yet moveable by thrusting them through two pieces of cork which rest on the 
edge of the vessel. If into the apparatus so prepared common water be pour- 
ed, and the battery charged, the calcareous matter, which is separated by the 
decomposition of the salts of lime in the water, and causes turbidity, will not 
only show by its own movements a continual flow of the water from the posi- 
tive pole in lines curved downwards, and then bending upwards to the nega- 
tive pole, but will likewise delineate the course of the current by particles ad- 
hering to the surface of the glass plates.*' ***** 

" But the repulsive power of the positive and attracting power of the nega- 
tive pole is seen much more satisfactorily, if the water in contact with each 
pole is separated by a stratum of porous matter, so that the particles which are 
impelled from one towards the other pole may pass through the interstices, 
while the cohesion of the interposed body may prevent other particles from 
passing in the opposite direction by their own gravity. Which conditions, in 
fact, are easily fulfilled by taking a tube of the form of the letter U, filling its 
curve with sand, and its straight, upright limbs with water. The two wires 
being now immersed in the water in the two limbs, and the galvanic circle con- 
sequently completed, the water will be observed slowly to sink in the positive 
and rise in the negative end of the tube. With a voltaic pile composed of ninety- 
two silver roubles, and as many plates of copper, a tube 7£ inches long, and 
wires made of platinum, I found that in fifteen or twenty minutes, the water 
stood ten lines higher than before in the negative, and as much lower than be- 
fore in the positive end of the tube. On interrupting the galvanic circle, the 
water soon returned to its original level, and on restoring the continuity of the 
circle, the transfer recommenced. Next day, fourteen hours after the experi- 
ment began, the positive limb was empty, the negative limb was full to over- 
flowing. After observing that it continued thus for four days, I interrupted the 
galvanic circle again, and the water soon returned to its equilibrium of level." 

"A similar but much more wonderful result was obtained when the inter- 
posed substance consisted of clay. I prepared a quadrangular prism of moist 
potter's clay, ten inches long and two inches in breadth and thickness. At 
each end of this prism, and five inches apart from one another, I fixed, half an 
inch deep in the clay, two glass tubes three inches long, an inch in diame- 
ter, and open at both ends. I then poured into each tube an inch of water and 
covered each of them, (loosely, however, so as to allow a passage to the air,) 
with a cork, through which the two wires of the battery were passed down to 
the middle of the water. The pile consisted this time of seventy -four double 
plates, such as those used in the last experiment. The following phenomena 
took place. As soon as the electric circle through the wet clay was completed, 
which was indicated by the escape of air-bubbles from the water, the clay bot- 
tom of the positive tube began to swell and raise the sand, with a thin stratum 
of which I had covered it to keep the water from becoming muddy. In the 
course of half an hour the clay appeared softened to mud, a part of which pierc- 
ed through the sand, and projected upwards like a little hill. By and by the 
pyramid discharged from its apex a muddy liquid, which ran down the sides 
like lava, and soon formed over the sand a layer of mud three lines in thick- 
ness. This beautiful appearance brought forcibly to my recollection the ac- 
counts given of the phenomena of mud volcanos. The explanation obviously 
was, that, when by the impulse of the positive pole the water was thrust to- 
wards the negative pole upon the clay at the bottom of the tube, the clay was 
softened, and the water in subsequently piercing the clay, threw the mud up- 
wards and around it, just as a gimblet does while piercing wood. For half 
an hour no change was observed in the level of the water in either tube, and the 
sand and clay remained in the negative tube quite undisturbed. But when 
three hours had elapsed, the level of the water in the negative tube had risen 
one line, in twelve hours it had risen two lines and a half; and in the meantime, 
the whole water of the positive tube had entered the clay, and the surface of the 



20S QUARTERLY PERISCOPE. 

mud was about two lines lower than the original situation of the water. The 
following- night the mud in the positive tube had sunk so far that the wire was 
not immersed in it; consequently the electric circle was interrupted. Neverthe- 
less I found the level of the water in the negative tube a quarter of a line 
higher than before, and the clay in the positive tube was firm on its surface. 
The positive wire being then depressed so as to restore the continuity of the 
galvanic circle, the clay of that side gradually became firmer and more dry, 
while the water rose in the negative tube. At length in two days the latter 
had attained its highest level, namely, 3£ lines above its original surface, while 
the clay in the positive tube had become so dry as to crack. In two days more 
the cracks were larger, but the level of the water in the negative tube was not 
higher, probably because any further increase it might have received was com- 
pensated for by evaporation. That no more than one-third of the water which 
disappeared from the positive appeared in the negative tube, — is to be explain- 
ed partly by its having evaporated, partly by its having been diffused and re- 
tained in passing through the clay between the tubes." 

In addition then to the hitherto known properties of the electric current, it is 
endowed with the power of impelling fluids in a direction from positively to nega- 
tively electrified bodies. This power Dr. R. denominates the vis electricitatis hydra- 
goga,- he resorts to it to explain some terrestrial phenomena, and also the move- 
ment of the blood through the capillary system of animals, and he shows satis- 
factorily that the action of the heart is completely inadequate to the latter pur- 
pose. Dr. R. is of opinion that the arterial system is in a state of positive, and 
the venous system in a state of negative electricity; the correctness of this 
theory, however, remains still to be proved by experiment and observation. 



PATHOLOGY. 

18. General Induration of the Arterial System. — A man, aged fifty-six years, 
entered the Hospital of Toulon for the treatment of an old ulcer of the left leg, 
which leg was covered with varicose veins. The foot had been amputated at 
Smyrna, in consequence of a viper-bite, some time previously. He also com- 
plained of pain in the left feidt, the little toe of which was observed to be swell- 
ed, cold, and of a bluish colour. This man, who was naturally robust and vigor- 
ous, had been worn down by long privations and profound chagrin. His an- 
swers and his countenance indicated a deep melancholy; he had little appetite; 
sleep short and interrupted; pulse large, slow, and irregular; the heart beat 
over a very large surface. The gangrene extended rapidly, and was consider- 
ed as the consequence of the disease of the heart, which was quite unequivocal. 
As mortification destroyed the different parts they were removed. The pain 
was insupportable; the pulse became slower and slower, and the arteries offer- 
ed such a degree of resistance to pressure as led to the conviction that they 
were ossified. 

On dissection, the heart attracted great attention. It was extremely en- 
larged; and there were several white patches on its surface. The left ventricle 
offered as much resistance to the scalpel as thick and dried parchment. The 
origin of the aorta, as well as the aortic valves, were completely cartilaginous; 
and this was the case with the whole of the aorta, the iliac and crural arteries, 
and their branches. There were several portions of these various arteries ossi- 
fied, besides the whole being cartilaginous. " The arteries of the upper extremi- 
ties were in a similarly indurated condition." — Ephemerides de Montpellier, 1828. 

19. Case of almost complete Obliteration of the Aorta. — A very interesting case 
of this description is related in the fourth number of the Journal Hebdomadaire 
de Medecine, A shoemaker, aged ninty-two, was admitted into La Charite, June 
19th, 1817. He was of small stature, with a small bald head, and a retiring 



Pathology. 209 

Forehead. His legs were very much bowed; his intellects, greatly weakened, 
scarcely permitting- him to give any satisfactory account of his previous history. 
He, however, said that he had suffered from a paralysis of the right arm, and 
that his mouth had been drawn on one side. At the period of his admission he 
could use both arms equally well, though his right hand was slightly bent. The 
temporal arteries beat forcibly; the pulse was hard, frequent, and regular; the 
skin hot, the tongue hard and dry; but notwithstanding this he demanded food 
continually. He was at first constipated, and afterwards purged. With respect 
to the chest nothing particular was observed, excepting that percussion below 
the right clavicle produced a more obscure sound than on the other side at the 
same spot. As he continued constantly in the horizontal posture on his back, 
a gangrenous eschar formed on the sacrum. After a long residence in the hos- 
pital, he died without any remarkable symptom. The examination of his body 
took place twenty-four hours after death. There was slight effusion beneath 
the arachnoid membrane; and the tissue of the pia mater was infiltrated; these 
two membranes were readily raised up. The two hemispheres of the brain, 
particularly that of the left side, presented many traces of previous apoplectic 
effusions of small extent: the most considerable was found in the substance of 
the left corpus striatum. The heart was of the ordinary size; the lining mem- 
brane of the left ventricle was a little thickened; the sigmoid valves exhibited 
some points encrusted with osteo-calcareous particles. The aorta, at its origin, 
was nearly of its ordinary size: it soon gave off the innominata, the calibre of 
which was much greater than natural. After having given off this branch, the 
aorta, much diminished, proceeded upwards and to the left, in the direction of 
the carotid of that side, and then turning at an almost acute angle it descended, 
presenting a slight enlargement at the point where the arterial ligament united 
with it. Near this spot the left subclavian was given off, which, very much di- 
lated at its origin, passed almost directly upwards, diminishing sensibly in size, 
without having furnished any other branch. The aorta immediately afterwards 
presented a very considerable circular contraction, such as would be produced 
by a ligature drawn very tight; then resuming its size, it presented a slight en- 
largement, which was more evident on the left than on the right side. The 
aorta then continued to descend in the abdominal cavity, where its calibre ap- 
peared to be smaller than natural. This difference was more perceptible to- 
wards its lower portion, and the external iliacs did not seem to be in propor- 
tion to the size of the lower extremities. From the termination of the right sub- 
clavian, which was remarkable from the increase of its volume, several arteries 
of a large size arose; the transverse cervical and the deep cervical, each of them 
equal to the humeral artery, followed their usual course, and were remarkable 
for the thickness of their coats, and the great number of their bendings. The 
first of these arteries, after having arrived, (without diminution,) towards the 
angle of the fourth and fifth rib, penetrated between their interval, furnished 
the corresponding anterior and posterior intercostals, passed a short space upon 
the pleura, and then continuing its course with one of the intercostal arteries, 
emptied itself into the aorta half an inch below its contracted portion. The 
deep cervical presented this peculiarity — that running a shorter course, and de- 
scending more directly along the posterior and superior part of the back, it di- 
vided into three large branches, which, penetrating separately into the chest, 
between the intervals of the four first ribs, and equally furnishing the corres- 
ponding intercostals, arrived at the aorta, into which they emptied themselves 
by as many large openings. The same disposition was observed on the left 
side; but, besides, on that side the superior intercostal was remarkable, which, 
arising from the subclavian, became confounded with the trunk of the second 
aortic intercostal. 

The right and left internal mammary arteries were remarkable from their 

considerable size: they were larger than the humeral arteries; both of them, after 

running their usual course, lessening somewhat towards the inferior part of the 

thorax, again increased sensibly in calibre, and became very tortuous; thencon* 

No. VII.— May, 1829. 27 



210 QUARTERLY PERISCOPE. 

tinuing their course with the epigastric, and forming with it one trunk exceed- 
ing in size that of the external iliac, terminated in the crural artery, which be- 
came somewhat enlarged. Before giving- rise to the profunda, the crural artery- 
gave off a pretty large branch, which was traced to the external obturator mus- 
cle. The right epigastric artery was a little larger than the left. The coats of 
the aorta were not changed in structure, excepting in a few points, where they 
were a little thickened. Near to the contracted portion the membranes ap- 
peared to be also in a state of integrity: seen from within, the contracted por- 
tion was exceedingly regular, and its diameter was that of a crow-quill. 

Explanation of the Plate. — Pi. If. aa. The heart, b. Pulmonary artery, c. Arte- 
rial canal obliterated, d. Aorta at its origin, e. Aorta considerably diminished in 
volume after giving rise to the arteria innominata. /. Contraction of the aorta. 
gg. Descending aorta, hh. Primitive iliacs. ii. External iliacs, their calibre less 
than natural, hh. Crural arteries larger than the iliacs. /. and m. Arteria inno- 
minata and right subclavian, nn. Internal mammaries, considerably augmented 
in size and continuous with the epigastric arteries, oo. Epigastric arteries 
equally enlarged and tortuous, pp. Deep cervicals dilated and communicating 
by free anastomoses with some of the intercostals. qq. Intercostal arteries, rr. 
Transverse cervical arteries anastomosing with other intercostals. ss. Intercos- 
tals communicating with the transverse cervicals. tt. Intercostals in their natu- 
ral state, u. Left subclavian increased in size. w. First intercostals anasto- 
mosing with the third. 

20. Account of Dr. Gall's Disease. By Dr. Robouam — This celebrated man 
was of middling size: his chest large, and his limbs muscular. His head was 
voluminous, his forehead high and broad. Possessed of a vigorous constitution, 
he was enabled to give himself up to assiduous and fatiguing labours, which 
occasioned but slight derangement of his health at long intervals; for instance, 
two or three attacks of gout, and some gastro-intestinal affections, &c. 

Of late years, his walk was heavy; and, when he ascended the stairs, he 
experienced difficulty of breathing and palpitation. About eighteen months 
since, these symptoms became more intense, and obliged him to keep himself 
in a state of repose, to follow strict regimen, and frequently to lose blood. An 
attentive examination by M. Dennesi, Rostan, Andral, and myself, enabled us to 
detect hypertrophy of the heart, with dilatation especially of the left ventri- 
cle. After some months, M. Gall was enabled to resume his habitual occupa- 
tions. In November he commenced his lectures at the Atheneum, which he con- 
tinued without interruption to the third of April last, when, on returning home, 
he experienced symptoms of cerebral congestion. On the 20th, the left side of 
the face was contracted, with debility of the extremities of the right side. 

The symptoms continued unabated during the month of May. The admi- 
nistration of purgatives occasioned prolapsus of the rectum and hemorrhoidal 
tumours, with slight exudation of blood. The spine and weakened limbs were 
rubbed with the balsam 'Nervins.' The third friction produced an attack of 
gout in the hand and foot, which yielded, at the end of several days, without 
amelioration of the other symptoms. The employment of a dozen * douches' 
produced no benefit. 

M. Gall then, by the advice of M. Fouquier, and several other physicians, 
saw Dr. Sarlandiere, who electrified him eighteen times, and three or four 
times acupunctured the epigastric region, because the functions of the stomach 
had latterly become impaired; all was ineffectual; and, it being thought advisea- 
ble to try country air, he was removed to his house at Montrouge. 

In addition to the other symptoms, nausea and want of appetite supervened. 
On the 13th of July he took an emetic, which produced several vomitings, and 
two stools, with some relief. On the following day, a few spoonfuls of wine 
were administered with the view of reviving the action of the stomach. The 
left foot was now attacked with gout. The tongue was red and dry, and the 
stomach rejected food. 



Flate Z Vol A 



2 cute %20 




J.Dravcon S 



Pathology. 211 

About this period, Drs. Broussais, Koreff, Dennesi, and Robouam met in consul- 
tation, and were of opinion that the brain was affected, coupled with hypertrophy 
of the heart and gastro enteritis. The latter affection excited particular attention. 
Mucilaginous drinks, ice triturated with sugar, nutritious and sedative clysters, 
frictions with a sedative liniment on the epigastric region, and even little moxas 
were had recourse to. M. Broussais entertained the most unfavourable prog- 
nostic, founded on the wasting of the patient, and the bad state of the digestive 
organs. 

It ought not to be omitted that, during the whole course of the disease, no 
marks of febrile action were perceived; but M. Dennesi had observed, that the 
symptoms exacerbated in the afternoon. 

On the 6th of August the uneasiness of the patient was more evident. 
About two o'clock he was chilly, the skin became pale, the pulse varied, but 
no reaction. The stomach remained in the same state, the mucilaginous drinks 
passing with difficulty. 

Moxas were ordered to be applied at seven o'clock in the evening; but at 
two, he had a violent shivering which lasted an hour, and was followed by an 
instant of reaction; the pulse increased to 85; many shirts were wetted by per- 
spiration. He now insisted on taking the sulphate of quinine; — six grains were 
administered in a clyster, and fourteen given by the mouth, in the course of 
the twenty-four hours. 

The intellect was good, the face natural, the tongue dry and red, the lungs 
performed their functions, no intermittence was perceived in the pulse. The 
belly free from tension, swelling, or pain. Chicken broth and gum water passed 
no longer with difficulty, which had occasionally occurred. 

The 8th, 9th, 10th, 11th, and 12th, the pulse was never below 84, nor 
above 92. The exacerbations after dinner were not remarkable. Twenty-four 
grains of sulphate of quinine were administered in twenty-four hours. About 
a pint of chicken broth or gum water was taken daily, and digested without 
difficulty; latterly, we remarked that the colour in the face increased; the eyes 
began to have a wandering appearance, the ideas became incoherent; in a 
word, the breaking up of the faculties had commenced. 

The early part of the night from 12 to 13 was tranquil: the latter greatly 
agitated. There was an excitement in the brain which was combated by sina- 
pisms to the legs, and a clyster of musk, camphor, and sulphate of quinine. 

On the 13th, drowsiness; he was visited by his intimate friends; he neither 
testified pleasure, nor spoke to them. The functions of the brain were evi- 
dently more impaired. The face red. Eyes still more wandering, and open. 
The limbs were supple, and free from spasmodic twitches. 

Twelve grains of sulphate of quinine were given in the course of the day. 
Bilious matter has been vomited for some days past. 

14. — All exciting medicines were withdrawn; the use of " adoucessants" 
was resumed, with warm cataplasms and sinapisms to the extremities, and 
clysters of farinaceous materials. The symptoms nevertheless continued to in- 
crease from the 16th. The patient was in a profound calm, and with few signs 
of sensibility. 

21. — About eleven o'clock in the evening, the circulation became quick 
and irregular; the respiration laborious. In which state of agony he conti- 
nued until the following evening, when the scene was closed in death. 

Dissection, — Head large and heavy; the cranium twice the ordinary thick- 
ness; strong marks of the meningeal artery on its inner surface; infiltration of 
serum in the pia mater; arachnoid raised throughout the whole extent of the 
hemispheres. Four or five ounces of serosity at the base of the cranium. The 
brain was not cut, being intended to be preserved in spirits of wine entire. It 
weighed two pounds ten ounces and a quarter. The right lobe of the cere- 
bellum was larger than the left. At the upper part and right side of the falx 
cerebelli, a small fibro-cellular tumour exists in the substance of the brain, 
about the size of a nut, pedicled and osseous in the centre. The vessels of the 



212 QUARTERLY PERISCOPE. 

brain are generally gorged with blood. The softness of the brain, supposed to 
exist during life, by the attending physicians, could not be ascertained, as it was 
not cut into. This state was supposed to occasion the debility of the right 
extremities, which is the more probable, as the serous effusion evidently took 
place at the close of life. 

Chest. — The lungs were sound, and without adhesion to the pleura. Heart 
one-third smaller than usual; soft, and containing a moderate quantity of blood, 
half liquid and half coagulated. Its cavities were larger than usual, and its 
walls thick, especially those of the left ventricle. In the arterial valves, os- 
seous points are felt. The transverse arch of the aorta is evidently dilated. 
The internal membrane of the arteries is red, and this redness is remarked 
even as far as the femoral and branchial. 

Abdomen. — The stomach was large, and its parietes thickened; its mucous 
membrane red, thick, and softened. It was also eroded in many points; its 
vessels distended with blood. The mucous membrane of the duodenum, jeju- 
num, a portion of the ilium, right colon, and its transverse arch, were red, 
thickened, and softened. The glandulse Peyeri turgid. No ulceration was 
found. The gall-bladder is divided in two by a hard and thick fibro-cellular 
intersection, and which interrupts all communication between the two cavities. 
One is large, and of a brilliant whiteness; the other possesses the ordinary ap- 
pearance of the gall-bladder. The first contained puriform matter, and many 
calculi; the other bile, with calculi. The liver was healthy. — Annates de la 
Medecine Physiologique, Sept. 1828. 

21. Hypertrophy of the Brain. — " Hypertrophy of the brain has been latterly 
considered a primary disease of this organ; yet it has been, up to the present 
period, but vaguely described: and, indeed, the structural anomalies and pa- 
thognomonic signs of this disorder are not to be understood nor explained with- 
out an attentive study of some well defined cases. M. Dance has for this pur- 
pose adduced several very interesting ones; but he is properly careful to inform 
us, that he does not apply the term hypertrophy to an augmentation of the brain 
resulting either from inflammation of its substance, from serous or sanguine con- 
gestion there, or from effusion into its cavities. For the afflux and stagnation of 
the fluids may increase the apparent dimensions of this viscus, but are not in- 
corporated or identified with its substance, whilst real hypertrophy, he main- 
tains, essentially consists in an unnatural augmentation, either as to bulk or 
number, of the constituent molecules peculiar to each organ. Now the brain 
is liable to this excess of nutrition, and ultimately to acquire a volume dispro- 
portionate to the capacity of its osseous receptacle. 

" M. Dance details four cases, which are quite sufficient to prove the existence 
of this disease; but they are not numerous enough to furnish a complete history 
of this remarkable change of structure, though they tend considerably to im- 
prove our acquaintance with several of its distinguishing peculiarities. The fol- 
lowing conclusions may be deduced from his cases. 

" 1 . Preternaturally increased nutrition of the brain is characterised by the flat- 
ness and approximation of its convolutions, the coarctation of its ventricles, and 
the unusual whiteness and firmness of these parts, and by a singular dryness of 
its parenchyma and of the arachnoid cavity, whilst the general texture of this 
viscus evinces no sensible alteration. 

" 2. Hypertrophy has been repeatedly observed to predominate throughout 
the whole of the cerebrum; but never in the cerebellum. 

" 3. Hypertrophy is so far from increasing the action and energy of the brain, 
that it decidedly tends to diminish, deteriorate, and suspend them; and these 
effects are no doubt owing to the continual pressure which the contents of the 
cranium are necessarily compelled to suffer, to a greater or less degree, in 
every instance of this ailment. 

" 4. As the symptoms of hypertrophy have varied in different individuals, we 
are not yet prepared to define it with precision and correctness. However, this 



Pathology. 213 

affection would seem to be developed very gradually, and under the influence 
of extremely occult cases. 

" The adult age may be considered a predisposing cause, (since, in all the 
four cases alluded to, the patients were between twenty and thirty years old;) 
and, as occasional ones, contusions of the head, (Case 1st,) and frequent deter- 
minations of blood to that part, (Case 4th.) But though every one of these 
causes seem to be of an inflammatory kind, yet this affection appears to arise 
essentially from excess of nutrition. For, if we admit that inflammation is the 
cause, we must also admit that this identical inflammation has simultaneously 
invaded all the textures of the brain, and affected them all in the same manner 
and to the same degree, notwithstanding the different functions they perform, 
and their ultimate peculiarities of structure. But inflammation does not usually 
proceed in this manner. In a single organ, and especially in one so complicat- 
ed as the brain, inflammation often produces at the same time, congestion, ra- 
mollissement, suppuration, and induration. These considerations would induce 
the belief that hypertrophy is the effect of morbid nutrition: and if so, it is not 
difficult to conceive that the brain, submitted to an uniform stimulus of nutri- 
tion, must become eventually more dense in a similar uniform ratio." — Lond. 
Med. and Phys. Journ. Dec. 1828, from Repert. d'Anat. 

22. Case of Psoas Abscess, pointing on the Anterior part of the Dorsum Mi. — " A 
young and strumous looking- woman was long in St. George's Hospital, under 
the following circumstances. Between the great trochanter and anterior spines 
of the ilium, in fact at the anterior edge of the dorsum of that bone, was a mid- 
dling sized tumour, which fluctuated and presented all the characters of abscess, 
accompanied with hectic and other constitutional symptoms. Mr. Jeffreys, 
whose patient she was, pronounced the disease to be psoas abscess, though 
perfectly unable to explain the rationale of its pointing where it did. Latterly, 
symptoms of phthisis pulmonalis were developed: the young woman fell to the 
charge of the physicians and died. The swelling, we should mention, was 
never punctured, and never burst. 

*' On dissection, the lungs were found greatly diseased, and presented 
abundance of tubercles and vomicae. The local appearances, however, were 
those which naturally attracted most attention. The body of the last lumbar 
vertebra was generally unsound, and partly destroyed on its left side by caries; 
the inter-vertebral substance between it and the fourth lumbar vertebra was 
gone. From this point you could trace the bed of an abscess in the substance 
of the psoas, just above, or more correctly anterior to, the level of the lumbar 
nerves, down to within two inches of the ligament of Poupart. Here the ab- 
scess had, as it were, bifurcated, forming for itself two paths — one in the re- 
mainder of the course of the psoas, the other diverging to the outside of the 
thigh, where the swelling had appeared during life. Let us first pursue the 
latter. Leaving the psoas at the point above mentioned, the channel of the 
abscess traversed obliquely the substance of the iliacus internus, crossed be- 
neath Poupart's ligament close to its iliac attachment, held on its way beneath 
the rectus at its origin, and finally ended at its outer side. The anterior crural 
nerve naturally lies rather deep between the iliacus and psoas muscles. The 
abscess, however, taking very nearly this direction, the nerve had it some de- 
gree avoided it, by describing the segment of a large circle, and moving much 
nearer the crest of the ilium. Besides this mal-position, it was matted to the 
neighbouring parts; notwithstanding all which the patient had complained of 
no unusual pain during life. 

" The other division of the abscess accompanied the psoas, betwixt it and 
the margin of the acetabulum, as deep as the trochanter minor. Here it formed 
a cavity nearly the size of an egg, situated, however, at too great a depth to 
admit of its detection during life, or even to be felt from without after death. 

"Thus, then, this case was a compound of common "psoas abscess," fol- 
lowing, perhaps more deeply than usual, the course of the muscle, and another 



214 QUARTERLY PERISCOPE. 

variety taking this new, and, as far as we know, undescribed direction. The dis- 
section is important, as explaining the quomodo here and assisting diagnosis 
hereafter." — London Medical Gazette. 

23. Case of Suppuration of the Spleen. By Dr. Gliojtka. — The tissue 
of the spleen does not appear to be very prone to suppuration. This or- 
gan is often discovered, on post mortem examinations, in a state of dis- 
ease, but its diseases are not often attended with the formation of pus. 
Dr. Glionna relates a case in the Osservitore Med. di Napoli for July, which 
he considered to be an extensive abscess of the spleen, and which he eva- 
cuated by means of a trocar. The result was favourable. The following 
is the substance of the case: — Dominique Rotunno, aged twenty-nine years, 
was affected for a long period with obstruction of the spleen, consequent to 
intermittent fever. An excess of food and of exercise rendered the tumour 
larger and more painful; and Dr. Glionna discovered at the same time, well 
characterised splenitis. In spite of bleeding, of the application of great num- 
bers of leeches, of purgatives, and tartarized antimony, the disease gained 
ground; the tension of the hypochondrium and the pain increased, accompa- 
nied with paroxysms of shivering, followed by heat and nocturnal perspiration. 
The spleen then lost its former hardness; it increased in volume, and became 
soft at its inferior part. Having found that the inflammation had passed into 
the state of suppuration, Dr. Glionna now applied emollient cataplasms to the 
side, and at the expiration of six days, the fluctuation was such as to induce 
him to propose puncturing the tumour, which was done by means of a trocar, 
at the distance of about four inches from the linea alba. There immediately 
issued from the abscess about three pounds of thick, very fetid pus, of a pale 
white colour at first, and then of a reddish tint. The patient was instantly re- 
lieved. The wound was kept open for some days; but by the eighth day it had 
closed, and the patient, re-established in health, soon acquired flesh and 
strength. — Lond. Med. and Surg. Journ. Jan. 1829. 

24. Bone found in the Heart. — Dr. Barbier, of Amiens, presented to the 
Royal Academy of Medicine, a very slender osseous body, an inch and a half 
long, and pointed at its two extremities, which he had extracted after death, 
from the right ventricle of the heart of a man sixty-two years of age. This bone 
had pierced the ventricle in three places, and had commenced to pierce it in 
three others. The heart had probably pierced itself in its contractions, as the 
bone was situated transversely in the ventricle. — Archives Gtntraks, Dec. 1828. 

25. Case of Perforation of the Duodenum. By M. Robert. — Louis Laurin, 
aged seventeen, complained for several months of obscure pain in the epigas- 
trium. For the last six weeks there was, in addition to this, diarrhoea, and for 
the last ten days, loss of appetite, nausea, and general illness. The 10th of 
December, 1827, three hours after his repast, which had been more copious 
than usual, he was suddenly seized with a severe pain, which, commencing at 
the region of the stomach, soon extended over all the abdomen; he vomited 
what he had eaten, after which, coloured mucosity and bile were ejected. He 
was taken on the morrow to the Hotel Dieu; the face was pale and altered; the 
skin covered with cold perspiration; the pulse frequent and small; the abdomen 
tense and very painful; the tongue pale and moist; and he had some bilious vo- 
mitings. Forty leeches to the abdomen,- emollient fomentations. He expired at 
four o'clock the following morning. 

Sectio Cadavcris. — The abdominal cavity was filled with gas and a quantity 
of reddish, very foetid, serous fluid; the peritoneum had lost its natural aspect; 
it presented in diverse points a red colour, running in striae or in patches; the 
intestinal convolutions were slightly agglutinated together; the peritoneum 
was generally little adherent to the abdominal muscles, from which it was easi- 
ly detached. The mucous membrane of the stomach appeared healthy. At the 



Pathology. 215 

origin of the duodenum, close to the pylorus, was found an oval ulceration, 
from three to four lines in diameter, with round, smooth edges of a grayish co- 
lour; the bottom of this ulcer consisted only of the peritoneum, which was of 
a yellow colour, and presented a perforation of about a line in diameter; which 
perforation formed a free communication between the cavity of the intestine, 
and that of the peritoneum. Near this ulcer was found another of a similar size, 
but not so deep, which penetrated the mucous membrane only. The rest of the 
intestinal tube was perfectly healthy. — Journal Universel, Aoht, 1828, 

26. Dysentery. — Dr. Christisokt has published in the Edinburgh Medical and 
Surgical Journal, for January last, a very interesting notice of an epidemic dy- 
sentery which has lately prevailed in the Edinburgh Infirmary. "The appear- 
ances found on dissection were the various stages in the effects of inflammation 
on the mucous membrane of the rectum, colon, and sometimes too of the lower 
part of the ileum. In the acute cases, which terminated fatally so early as the 
tenth or eleventh day, the most extensive derangements of structure were re- 
marked; in the more lingering cases, which after the first eight or ten days as- 
sumed the external characters of chronic diarrhoea, and proved fatal in four, six, 
or eight weeks, the disorganization was in general less extensive. The appear- 
ances observed were redness of the inner membrane, thickly scattered ulcera- 
tions, most abundant over the longitudinal bands of the colon, commonly occu- 
pying and destroying the rugae, seldom penetrating beyond the inner surface of 
the muscular coat, frequently stripping that membrane of large patches of 
its mucous coat, frequently also covered by shreds of lymph, and sometimes 
by red, spongy, fungoid granulations. Even in the most acute cases, although 
no scybala had been discharged during life, the colon was found empty of 
feces. The other organs in the belly were not affected; and in particular the 
liver, which has been supposed by some tropical practitioners to play an im- 
portant part in the parallel dysentery of hot climates, did not in a single instance 
deviate from its healthy condition." 

27. On a Disease of the Stomach, which produces a well defined perforation of its 
tunicSy without softening of their surrounding structure. We noticed in our last 
number p. 452, some very interesting cases of this description related by Dr. 
Ebermaier, in the Journal Complementaire, for July last. Two or three more 
cases of the same description are given by Dr. E. which we shall omit, as also 
the opinions of several physicians cited by him, and proceed to lay before 
our readers the views of Dr. E. on this subject. He is of opinion that the cases 
he has related prove the existence of some common morbific cause, which 
could produce so striking an uniformity in the appearances seen upon dissec- 
tion. He observes — 1. That in every case the disease was extremely slow, 
being gradually developed in the course of several years. 2. In no instance 
was the nature of the malady suspected by the physicians. The symptoms were 
so obscure in some instances, that an affection of the stomach was never thought 
of. The derangements of the digestive functions were considered to be sym- 
pathetic. The fatal termination of the disease was never anticipated. Death 
sometimes occurred unexpectedly, almost in the midst of apparent health. 3. 
The disease continued uninterruptedly, without any perfect intervals, as is 
frequently the case in true nervous cardialgia, although occasionally in so slight 
a degree that the patient considered himself in health. Severe pain did not 
usually occur until the last days of the patient's existence, and not always even 
at that time. The previous pains were slight, limited to a dull sensation of 
pressure in the precordial region, and to slight spasms. 4. Cachexy never 
followed this long train of symptoms. Although vomiting frequently occurred, 
the strength of the patient did not appear diminished, nor did his external ap- 
pearance indicate the existence of disease. Emaciation occurred only in the 
case related by Rauch, and that was an example of a complicated malady. In 
every other no hectic fever was observed, and death was neither the result of 



216 QUARTERLY PERISCOPE. 

exhaustion of the vital powers nor want of nutrition: it was sudden, and caused 
by the extravasation of the contents of the stomach, without which the patient 
might have continued to live. 5. The perforations were always found in the 
pyloric region, or near it. 6. The most attentive examination could not in any 
case detect the least vestige of inflammation or suppuration of the other parts 
of the stomach. The tunics of that organ were perfectly healthy, except in the 
spot perforated, and rather pale than red. 7. The appearance of the perfora- 
tion was always the same. Approaching a perfectly round form, and almost 
always of considerable extent, it penetrated uniformly all the coats of the sto- 
mach, so that the portion removed appeared to have been taken away in a very 
regular manner. The surrounding parts were never softened, nor the edges 
thinned. There was generally perceived around the opening a tumefied in- 
duration, but not tuberculous nor cartilaginous. It was regular, and lost insen- 
sibly in the healthy parts. 

Dr. E. considers the cases he has related particularly interesting, and calcu- 
lated to throw some light upon the true nature of these perforations, on account 
of the adventitious and thickened tissue which surrounded the apertures. It 
follows that the rupture could not have arisen from the thinness or local weak- 
ness of the part, but that it depended upon a regular and unifom process, con- 
tinuing without interruption from the commencement of the disease. 

It may then be concluded, that these regular perforations of the stomach are 
never the accidental or mechanical result of spasm. That the disease does not 
consist in scirrhus or cancer of the stomach. That it is not the termination of 
an ordinary chronic inflammation. Lastly, that it does not result from "ramol- 
lissement" of the parietes of the stomach. 

28. Singular case of Insanity caused directly by a fall on the head. — " A teacher 
of gymnastics fell from the top of a steep high stair head foremost, and pitched 
upon his head on a stone floor, where he la} r for a few minutes stunned. Next 
day his physician, Dr. Hausbrand, found him a-bed, in full possession of his 
senses, and complaining only of a pain in the head, on which no farther injury 
could be detected except a few superficial excoriations. He had passed a good 
night, the pulse and respiration were natural, and the functions of the brain 
were quite unaffected. This prosperous state continued two nights and a day, 
when matters suddenly took a different turn, without any fresh cause, and in 
the course of an hour he lost his reason so completely, that he spoke unintel- 
ligibly, got out of bed, insisted on leaving the house, stared right before him, 
would not answer questions, and did every thing confusedly and hurriedly. It 
was impossible to fix his attention on any thing, or rather he was constantly as 
it were absent in mind. Bloody serum at the same time issued from the right 
ear. In twenty-four hours more he became speechless, at least could not arti- 
culate, but from time to time uttered involuntary and unintelligible cries, and 
in reply to frequently repeated questions answered yes, without any regard to 
its meaning. The tongue appeared to have lost its voluntary movements. Be- 
ing placed in the warm bath, he at first evidently relished it; but on a bucket 
of cold water being dashed over his head, he screamed out and sprang from the 
bath, nor could any entreaty subsequently persuade him to enter it again; nay, 
whenever it was talked of, although in eveiy other particular he was com- 
pletely unconscious of what went on around him, he became greatly alarmed, 
and calling out no! no! endeavoured to make his escape. For three days this 
singular state continued, during which time he never expressed a want, though 
he ate and drank when food or drink was placed before him, and went to stool 
when he was placed on the night-chair. He had no sign of bodily illness; but 
nevertheless his expression of countenance was that of an idiot. At night he 
slept well and composedly; in the day time he lay passive in bed like one in 
the deepest brown study. He allowed himself to be undressed without resist- 
ance, yet without giving any aid; or to be led up and down the room, but 
seemed to be perfectly a passive machine, and to have no will of his own what- 



Pathology. 217 

ever. Leeches, cold cloths, and blisters were applied without any advantage. 
After this state had lasted three days, a fit of epilepsy suddenly took place, for 
which he was bled without any relief; and the fits recurred frequently for three 
days. Still his stupid moodiness continued. At the end of that period, tartar 
emetic was ordered on account of some gastric symptoms; and after the opera- 
tion of this remedy the epileptic fits became much milder. Next day, after the 
operation of another emetic, they ceased entirely, and the patient for the first 
time attended to what was going on around him, attempted to speak, and dress- 
ed himself. The emetic system was continued an entire fortnight, so as to ex- 
cite vomiting three or four times a-day; and during this period he recovered 
entirely, but with the following singular phenomena. 

When he first tried to speak, although he evidently had an accurate concep- 
tion of what he wished to say, he could not find the correct expression, or even 
a single proper word; but when any one spoke the sentence articulately to him, 
he repeated it, and with evident satisfaction. He had exactly the appearance 
of a person who struggled to make himself understood in a foreign language 
which he spoke but imperfectly. In fact he had lost, not the power of speech, 
but the knowledge of language; and, what was very remarkable, the languages 
which he formerly spoke most fluently he had now forgot most completely. A 
Pole by birth, he spoke Polish most fluently before, and had been in the daily 
practice of conversing with his countrymen in that tongue ; but now he under- 
stood much better his German friends than his Polish countrymen. Much less 
could he speak Polish, while nevertheless he spoke a little German, though not 
without help. With the Latin tongue he seemed still better acquainted; that 
is, he had not forgotten it so entirely. With Greek it was different; he had for- 
gotten it as completely as the Polish. He could read Latin or Greek authors 
with whose works he was formerly acquainted; but he could not translate Greek 
at all, or Latin without assistance. Every day, however, his command of lan- 
guage increased rapidly; so that passages in Latin and Greek, which were un- 
intelligible one day, he could easily translate the next. His former facility in 
understanding various languages returned in the following order. First, he re- 
covered his command of German, then he regained his knowledge of Latin, 
next that of Greek; and in the last place he recovered his command of Polish. 
It was also remarkable, that in no other respect was any weakness of memory 
observed, or diminution of judgment, or of any other faculty of the mind. The 
discharge from the ear bore no relation to its progress; for both when his illness 
was at its height, and during convalescence, it occasionally ceased for twenty- 
four hours without any injurious effect. It is added in the narrative, that for 
some years before, this man was of a gloomy disposition of mind, had a timid 
look and yellow complexion, and often thought himself sick, but that now his 
expression is clear, and his temper of mind cheerful.- — Edinburgh Med. and 
Surg. Journal, January, 1829, from Must's Magazin, 1828. 

29. Case of Disease of the Bladder, terminating in perforation and fatal extra- 
vasation of its contents. By M. Thevisseu. — In our last number, p. 453, we 
gave some cases in which a well defined perforation occurred in the stomach, 
without disease of the neighbouring part. M. Thevissen has communicated to Dr. 
Ebermaier a case of similar affection of the urinary bladder. — An unmarried 
woman, thirty-three years of age, whose health had never been disturbed by 
any serious illness, suddenly complained of very severe pain in the lower part 
ofihe belly. No cause could be assigned for the attack. She imagined it was 
possible that her attack might be dependent upon suppression of the menses, 
which had existed for four months. The lowerbelly was highly sensible to the 
slightest pressure. Thirst excessive. Extremities covered with sweat, and 
cold as marble. Countenance anxious, and with a yellowish tinge. Pulse small 
and quick. Abdominal inflammation was suspected, and a severe antiphlogis- 
tic treatment was instituted without any benefit. The pains increased in seve- 
rity. Frequent vomitings of a dark brown substance. The patient gradually 
No. VII.— May, 1829. 28 



21S QUARTERLY PERISCOPE. 

sunk, and died the night after she was attacked. She had had no motion, nor 
passed any urine, during her short but severe illness. 

Dissection. — A considerable quantity of fluid escaped from the abdomen, of 
an urinous smell. There was no trace of gangrene nor of inflammation. All 
the viscera were healthy. The uterus contained a four month's foetus. On the 
posterior side of the bladder, about the middle of its longitudinal diameter, a 
circular perforation was found, about two lines in diameter. The edges of this 
opening were neither gangrenous, inflamed, nor hard; they were as smooth as 
if a portion had been removed by a punch. In every other part the bladder was 
perfectly healthy. — Lond. Med. and Phys. Journ. from the Journ. Complement 
taire, July, 1828. 

30. Case of Paralysis of the Might Side, with Jljfection of the same Side of the 
Brain. By Dr. Leuret. — But few cases have been recorded in which a para- 
lysis of one side of the body has depended upon a disease of the brain of the 
same side, and even the possibility of the fact has been doubted. Dr. Leuret 
relates, in the Journal des Progres, Vol. XI. a very interesting case of this de- 
scription. A man, aged sixty-six, of a sanguineous temperament, was attacked, 
January 26th, 1828, with paralysis of the right side, with difficulty of speaking. 
On the 8th of February he entered the Hospital o£St. Charles, at Nantz, at 
which period he presented the following symptoms: mouth half open and drawn 
to the left side, tongue inclined to the right side, speech slow and difficult, almost 
complete immobility and insensibility of the right arm; pulse tense and very 
irregular, respiration abdominal. He died on the 13th of February, and on ex- 
amination, the cranium and dura mater were found healthy; the arachnoid was 
opaque on the right hemisphere of the brain, and slightly so on the left; yel- 
lowish softening near the right optic thalamus, and the corpus striatum of the 
same side presented a softened and grayish spot. 

31. Cartilaginous Degeneration of the Stomach. — Dr. Dieffee-bach relates in 
Rusfs Magazin, t. xxvi. the case of a woman who had for twelve years a move- 
able, round tumour in the abdomen, which many physicians had pronounced to 
be a scirrhus ovary. This woman was never affected with nausea, vomiting, or 
any of the signs usually attendant on scirrhus of the stomach. On examination 
after death it was found that the tumour was formed by the stomach itself, which 
had become cartilaginous, and at its anterior part an inch thick: at the poste- 
rior part of this viscus only there was a small membranous portion of less thick- 
ness. The cartilaginous parietes of the stomach could not exercise any move- 
ment or trituration whatever, whence it would result that the movement of this 
organ is not necessary for the comminution of the food. This specimen of pa- 
thological anatomy, so interesting for the physiology of digestion, is preserved 
in the Royal Museum at Berlin. 



MATERIA MEDICA. 

32. Laxative of Senna and Prunes. — " Of the many different methods of pre- 
paring this old-fashioned, but excellent domestic aperient, perhaps the follow- 
ing will be found to be the most pleasant and effective. Take of senna leaves 
half an ounce; supertartrate of potass, half a drachm; water half a pint; boil 
gently for ten minutes, and strain. To the liquor, put half an ounce of sugar, 
and half a pound of French plumbs; let them simmer until the liquor be nearly 
absorbed by the plumbs. 

"This old form has the advantage of being easily carried in the memory- 
half a pint of water, half an ounce of senna, half an ounce of sugar, half a 
drachm of cream of tartar, half a pound of plumbs." — Ijond. Med. and Surg. 
Journ. Jan. 1829. 



Practice of Medicine. 219 

33. Variolaria Amera as a substitute for Quinquina. — According 1 to M. Casse- 
beer, this species of lichen which grows in abundance on the bark of the beech 
tree m mountainous forests, possesses a bitter principle similar to that of the 
quinquina. It results from the experiments tried by the author upon this plant, 
that it has the same febrifuge properties as the Peruvian bark. — Archives Gene- 
rales, January, 1829, from the, Magazin fur Pharm. Feb. 1827. 

34. New Cinchona. — " M. Gondat, Professor of Botany at Bogota, in New 
Granada, has recently discovered a new species of cinchona in the extensive 
forests which surround the city of Muzo, to which he has given the name Cin- 
chona Muzonensis, with the following character: — Cinchona Muzonensis, foliis 
ovata-oblongis, acutis, basi attenuatis, stipulis revolutis panicula hachiata, co- 
rollis albis, Umbo imberbi." — Lond. Med. and Surg. Journ. Nov. 1828. 

35. Purgative property of Convolvulus Sepium. — " Twenty pounds of the root 
of this plant, gathered in April, yielded one pound twelve ounces, avoirdupois, 
of watery extract, which, in doses of from fifteen to twenty grains, acted freely 
on the bowels. Haller affirms, that the expressed juice of this herb, taken in 
the dose of twenty or thirty grains, possesses the virtues of scammony; and 
hence it is sometimes called German scammony." — Med. Botany. 

36. Effects of Bitter Almonds. — " Half an ounce of bitter almonds eaten in the 
morning, previously to taking food, produced at the end of half an hour violent 
pain in the head and nausea, which lasted for three hours; no other signs of 
poisoning were present. The vapour of ammonia being respired afforded no 
relief."-— £u//. des Sciences MH, Juillet, 1828. 



PRACTICE OF MEDICINE. 

37. Case of Gastro-entero-cephalitis, attended with malignant symptoms, and 
successfully treated. By M. Brottssais. — The tenth volume of the Annals of the 
Physiological Medicine contains a case of typhus gravior by M. Broussais, which 
I have been tempted to translate for the perusal of the American physician. It 
is every way worthy of his serious consideration; a most violent form of fever, 
attended with alarming symptoms, finally overcome by means so simple and 
apparently so inefficacious, as to astonish the active practitioner. Could we 
have the courage to follow pari passu the founder of the physiological medi- 
cine, and rely on similar means in the treatment of our fatal forms of fever, 
there is reason to believe that we should less frequently have to deplore the 
inefficaey of our art, and perhaps never the hurtful tendencies of our remedies. 
Let the stimulators meditate on this case, and compare it with similar ones in 
their own hands. 

The details might have been considerably abridged without detriment, but I 
thought it better to give them in full; for the case may be considered, as it re- 
gards the power of antiphlogistic treatment in these fevers, a specimen of many 
others scattered through the volumes of that valuable Journal. 

Henry Bethune, student of medicine, aged twenty years, of plethoric, robust, 
and well constituted habit of body, has been occasionally subject to derange- 
ment of the digestive function, which he usually treated with emetics. He has 
lived in Paris for the last eighteen months, and had more frequent attacks of 
this complaint, attended with violent head-ache, aggravated, no doubt, by his 
constant application to study. He had been for some days suffering from this 
complaint, without however relinquishing his daily pursuits, when on the 26th 
of February he took a walk with a friend during bad weather beyond the city, 
and returned to his lodgings in the evening affected with fever. 

The next day he was in the following state; tongue coated with white fur, 



220 QUARTERLY PERISCOPE. 

slightly red at the point and edges? mouth clammy, anorexia, thirst, nausea, 
tenderness of the epigastrium, diarrhoea, pulse frequent, hard and full, super- 
orbital pain, sleep frequently disturbed, contusive pains of the limbs. (Vene- 
section; perfect quietude; abstinence; milk and water for drink.) 

28th. Same state as yesterday, only the pulse is less tense, the head-ache less 
violent. 

March 1st. The whole abdomen painful on pressure, flatulency, borborygmi, 
with frequent liquid stools, pulse more frequent, not so full, but harder, head- 
ache more violent; the patient could scarcely support himself on his feet. An 
abundant epistaxis supervened during the night, which sensibly relieved him. 
(Ten leeches to the anus; emollient fomentations to the abdomen; gum water.) 
2c?. The night was calmer than yesterday; a slight remission of the symp- 
toms. 

3c?. Aggravation of the inflammatory symptoms; alvine discharges less fre- 
quent, tension of the abdomen, delirium during the night. 

4th. M. Broussais is called to the patient. Redness of the tongue more cir- 
cumscribed, appetency for cold drinks, epigastrium tumefied, tense, hot, and 
very painful; stools suppressed, urine scanty and high-coloured, with enaeorema; 
delirium at times furious, subsultus tendinum; pulse quick, small, and corded. 
(Fifteen leeches to the epigastrium, five to each temple; refrigerant applications 
to the head; gum-water for drink.) 

5th. Tongue dry, very red towards its point, covered with a fuliginous coat, 
and the patient scarcely able to extend it beyond the lips; breath foetid; sensible 
diminution of the pain and tension of the epigastrium; hypogastrium now tense 
and painful, borborygmi, discharges of foetid gas per anum, dysury, continuance 
of delirium, with loquacity alternating with muttering, carphology, subsultus 
tendinum, eyes haggard, hallucination, stupor, continual efforts to uncover the 
extremities, pulse small and quick. Towards night there succeeded to these 
symptoms a deep comatose state. (Six leeches to the hypogastrium; refrigerants 
to the head. ) 

6th. A very copious epistaxis came on about four in the morning, preceded 
by heat and redness of the face; the haemorrhage continued to flow during the 
day and following night. In consequence of this the patient gradually became 
more rational and collected; the countenance resumed its expression, the pulse 
rose, became fuller and less frequent; the tongue moister, and the hypogas- 
trium more supple. (Emollient cataplasms to the abdomen; continuation of re- 
frigerants to the head.) 

7th. Patient sensibly better. The tongue is less red, and its sooty coating has 
disappeared; abdomen supple, urine sufficiently abundant, free, and no longer 
high-coloured. He has had a copious alvine evacuation, very foetid, and as black 
as ink; (he had swallowed a great quantity of blood;) pulse less frequent and 
hard; thirst very great. The arrival of the patient's relatives afforded him gra- 
tification, and he conversed with them composedly. (Small enemata of cold 
water to be repeated two or three times in the day; refrigerants to the head.) 

8th. Prostration of strength, somnolency, intense thirst, desire for cold 
drinks, (he asked for a piece of ice;) abdomen has again become painful and 
tense, no alvine discharges; urine abundant, pulse again 100. (Refrigerants to 
the abdomen; cold enemata.) 

9th. Same state as last evening. (Same prescription.) 

10th. Dryness of the throat; tongue fuliginous; greater tension of the hypo- 
gastrium; bowels continue costive, frequent desire to pass urine; slight cough; 
transitory delirium; continual somnolency; eyes turned convulsively upward; 
subsultus tendinum. (Six leeches to the hypogastrium; emollient cataplasms 
to the abdomen instead of the refrigerants.) 

11th. Abdomen nearly in the same state; hardness in the left iliac region, at.* 
tributed to the distention of the sigmoid flexure of the colon. The leech-bites 
surrounded with a livid areola; frequent desire to void urine, especially after 
drinking much, it is pale and limpid; slight cough, pulse less frequent; somno- 



Pr actice of Medicine. 221 

lency. (A small enema of cold water; emollient cataplasms to the abdomen; 
acidulated barley-water for drink.) 

12th. Much the same as last evening-. Skin dry, with acrid heat. (An oily 
enema given, which produced two scanty, foetid and black stools.) 

13th. Copious stools during" the night, of the same odour and colour as the 
preceding- ones. Face pale, bluish, especially about the eyes; tongue, teeth, 
and lips covered with dark sordes; speech difficult; abdomen swollen and tense; 
thirst less; urine scanty; pulse frequent and small; cough trifling; delirium tran- 
sitory. (Cold applications to the abdomen.) Cough increased during the night, 
became very harassing, and without expectoration; respiration frequent; cheeks 
flushed; delirium constant, pulse very frequent, small and corded; thirst very 
intense. (Twelve leeches over the lower part of the sternum; emollients to the 
abdomen and chest, instead of refrigerants.) 

14th. Cough and disordered respiration nearly ceased; face flushed instead 
of being pale; pulse less frequent and fuller; tongue cleaning off; thirst abated; 
speech freer; abdomen less tense; urine not so abundant; stools less copious; 
delirium transitory; the patient asks for food. The subsultus tendinum con- 
tinues. (Emollient enema; emollient fomentations to the abdomen.) 

15th. Complexion clearer; expression of the countenance more natural; great 
desire for food; he talks only of eating; the sordes on the tongue and lips has 
nearly disappeared; he can put out his tongue with facility; abdomen supple, 
except in the right iliac region; has had two stools during the night; pulse less 
frequent; cough has ceased; delirium very slight. (Same prescription.) 

16th. Exacerbation during the night; delirium, agitation, subsultus tendinum; 
pulse frequent and fuller; cough, with quickened respiration; tongue and lips 
again covered with sordes; speech embarrassed; thirst more moderate; the pa- 
tient talks continually about eating; abdomen swollen and tense, especially in 
the hypogastric region; costive; discharge of urine scanty and involuntary. 
(Twelve leeches to the hypogastrium during the exacerbation; emollient 
fomentations; enemata.) 

17th. Great prostration of strength; face pale and dingy; eyes dull and 
sunken; cheeks and temples hollow; deep stupor; lies immoveable on his back, 
with constant tendency to slide down in the bed; arms perfectly relaxed and 
powerless; takes no notice of any thing; the organs of sense greatly blunted; 
continual moaning; lips, teeth, and tongue dry, and covered with brown sordes; 
deglutition difficult; refuses drink, which seems to pass into the stomach me- 
chanically; cough; respiration at times laborious; pulse frequent, small, and im- 
peded; heat diminished; abdomen sunken and flaccid; involuntary discharges 
of urine; the body exhales a strong odour of mice; costive. (Sinapisms to the 
legs; gum-water, with a sixth part of milk for drink.) 

18M. The patient scarcely moves his legs; the sinapisms, though very irri- 
tating, have produced but slight redness; pulse almost insensible, but fre- 
quent; cough continues; chest sonorous; respiration slow and easy; the pa- 
tient is roused from his stupor with difficulty; abdomen greatly sunken. (Sina- 
pisms. ) 

19th. Stupor and drowsiness less profound; the patient recognises those about 
him, and answers tardily but distinctly to questions; deglutition better; pulse 
fuller and less frequent; cough moderated, and attended with expectoration; 
voluntary discharge of urine; patient lays on his side; the surface of the body 
uniformly warm. (Gum-water with milk, and rice-water for drink.) 

20th. The night has been calm, as well as the greater part of this day; an ex- 
acerbation at night; cheeks flushed; tongue dry and coated; cough more urgent; 
pulse frequent and full; heat augmented; urine discharged involuntarily; lies 
on his side; a large eschar has taken place over the sacrum. (Diluted gum- 
water for drink; emollient enemata.) 

21st. Towards morning the somnolency ceased, and the patient became ra- 
tional; thirst great; desire for food; tongue moist and cleaning off; cough slight; 
pulse less frequent. Great prostration of strength with emaciation; urine dis- 



222 QUARTERLY PERISCOPE. 

charged voluntarily; bowels so torpid that the enemata are not discharged. At 
night a similar exacerbation with the preceding day, with obstinate drowsiness, 
taciturnity, stupor, moaning, cough, subsultus tendinum; frequent and small 
pulse; involuntary discharge of urine; lies immoveable in supination. (Sinapisms; 
enemata; gum-water.) 

22c?. During the day the same state as last night; sinapisms have produced 
no effect; exacerbation at night. (Same prescription.) 

23d. Same as yesterday; at night the cough is more frequent; the patient 
seems gay and talks much; continual emaciation; a copious stool obtained by 
an enema. 

24th. Nothing particular; exacerbation at night. (Gum-water for drink; ene- 
mata. ) 

25th. Cough very frequent; respiration accelerated; surface of the chest hot; 
cheeks flushed; pulse frequent; delirium; agitation; refuses drink; breath fetid; 
urine discharged involuntarily; he continually uncovers himself, and complains 
of a weight on his chest which threatens to suffocate him. (Emulsion for cough; 
enema; cataplasm over the chest.) 

26th. Patient much agitated during the night; cough frequent, and constant 
delirium; more calm in the morning; less pulmonary affection; a desire to void 
urine- (Emulsion; enemata; tepid drinks.) 

27th. Same state; remission during the day; exacerbation at night. (Same 
prescription.) 

28th. Nothing particular; cough relieved; pulse soft but frequent; the excre- 
tions very foetid, especially at night; patient continually uncovers himself; com- 
plains of the least weight on the abdomen; talks continually about eating and 
returning home; delirium constant even during the day. 

29th, 30th, 31st. Same state. (Enemata.) 

April 1st. Cough trifling; pulse frequent and tongue dry during the exacer- 
bation; no thirst; great desire for food; bowels opened; urine scanty and high- 
coloured. (Enemata; small quantity of decoction of arrow-root.) 

2c?. Cough increased; pulse frequent; skin hot; cheeks flushed; delirium 
aggravated; urine suppressed; bowels costive. (Calming potion; gum-water; 
enemata.) 

3d and 4th. Cough trifling; pulse soft and small in the day, frequent at night; 
also at this time tongue dry, and speech embarrassed; progressive emaciation; 
eschar over the sacrum detaching with abundant suppuration; great desire for 
food; sleep at night; urine turbid and scanty; less foetor of excretions. (Starch 
enemata; arrow-root.) 

5th, 6th, 7th, 8th. Cough ceased; pulse still frequent, from 90 to 95; emacia- 
tion extreme; tongue coated and dry; no thirst; urine scanty and turbid; lips 
red; senses of sight and hearing morbidly acute; great desire for food; the ene- 
mata have brought away a small quantity of hardened faeces; eschar detached; 
the surrounding parts inflamed, and very painful; hips and elbows on the point 
of ulcerating; a phlegmon in the integuments of the hypogastrium. (Enemata; 
gruel; rice cream; vegetable broth.) 

9th, 10th. Pulse not nearly so frequent; tongue moist and clean; speech na- 
tural; rational; moderate discharge from ulcer on the sacrum; phlegmon on ab- 
domen opened. (Rice cream; diluted milk; small quantity of animal broth.) 
From this time the food was gradually made more and more nourishing, and 
the patient gained sufficient strength to leave his chamber in a month, and 
finally recovered his original health and strength with the loss of his hair. 

We are convinced that if the relatives of Bethune had united in consultation, 
physicians holding different medical opinions, in order to get the quintescence 
of each, he would inevitably have perished. Usually on such occasions some 
heroic remedy is adopted, and we are decidedly of opinion that a blister, sina- 
pisms, or animal broth had recourse to, before the irritation had left the upper 
part of the intestinal canal, would have prevented the resolution of the disease, 
and finally exhausted the strength of the patient. When a gastro-enteritis is 



Practice of Medicine. 223 

very intense, it sometimes continues even till extreme emaciation is induced, 
and then is entirely removed. But if the physician, alarmed by the progress of 
the emaciation, trusts to stimulants before the digestive organs have lost their 
excessive irritability, which causes the brown sordes of the tongue and lips, 
and the stupor, the patient sinks in a few days* Hippocrates, who did not em- 
ploy stimulants in acute diseases, sometimes saw these cases continue even to 
the hundredth day; but, since the stimulant doctrines have predominated in the 
schools, we no longer witness these protracted cases. Malignant, nervous? putrid, 
adynamic, ataxic fevers are of short duration in the hands of the stimulators. 
We cannot endure the sight of a patient suffering for many weeks extreme 
prostration, with stupor and carphology; we imagine the inflammatory period 
to have passed away; we stimulate in order to strengthen, and we are far from 
attributing the fatal event to the use of these stimulants. 

Many physicians, who consider themselves more physiological in their notions 
than others, imagine that the gastro-enteritis in such cases as the above, has 
given place to arachnitis, and accordingly combat this affection with sinapisms 
and blisters. This practice is almost as dangerous as the other. In this way do 
we keep up the inflammation of the mucous membrane of the digestive organs, 
which finally wears out the patient's strength or extends the irritation to the 
vascular system, and even to the heart. We have before said, and we now re- 
peat it, that decided inflammation of the brain is a rare disease. Inflammation 
of the digestive canal is of itself capable of producing prostration, delirium, and 
stupor; arachnitis is attended with convulsive symptoms, much more violent 
than those which we observe to occur in the putrid fevers of authors. Besides, 
should there be even cerebral inflammation, that would afford no good reason 
for the employment of blisters and sinapisms. We have a long time ago object- 
ed to this practice, and Professor Lallemand, of Montpellier, has since con- 
demned it in the most decided terms from practical observation in his excellent 
work on affections of the brain. Why, then, continue to torment with rubefa- 
cients and blisters such as present some nervous symptoms in acute diseases? 
The words cerebral fevers has of late superseded in the parlance of physicians 
the terms adynamic fever, ataxic fever: the vulgar repeat the phrase, become 
accustomed to see blisters to the legs, and sinapisms to the feet, while ice is 
applied to the head, and now almost always require the conjunction of these 
remedies. It demands all the firmness of the physiological physician to resist. 
He should nevertheless remain unyielding; for violent stimulation of the skin 
only adds to the intensity of a gastro-enteritis, sufficiently severe to resist an 
active antiphlogistic treatment for the first few days. C. D. 

38. On the Hydrocyanate of Iron as a substitute for the Quinine. — Dr. Hasse 
has employed with success the prussiate of iron in an intermittent fever which 
prevailed at Gustrow in the spring of 1827. The sulphate of quinine was suc- 
cessful in almost every case, but as its expensiveness prevented Dr. H.'s pre- 
scribing it in all cases, he determined to try the efficacy of the Prussian blue. 
When the patient presented gastric symptoms, which was frequently the case, 
Dr. H. on the first appearance of the precursory signs of the paroxysm, admi- 
nistered five grains of ipecacuanha every ten minutes, until vomiting was pro- 
duced; or according to circumstances a laxative during the apyrexia. The hy- 
drocyanate of iron was then administered in the following form: — R. Hydro- 
cyanate of iron, grs. xij. — aromatic powder, or white pepper or mustard in 
powder, half an ounce; mix and divide into twelve powders; one powder to be 
taken every four hours during the apyrexia. Of course from four to six pow- 
ders were usually taken. Commonly the paroxysm which followed the admi- 
nistration of the febrifuge was so mild that three powders were sufficient in the 
second and third apyrexia, to keep off entirely the third paroxysm. To pre- 
vent its return, Dr. H. gave two powders on the seventh, fourteenth, and 
twenty -first days, and the fever did not return. The prussiate of iron adminis- 
tered in the above manner never produced ill effects, either upon the digestive 



224 QUARTERLY PERISCOPE. 

canal or upon the brain. It was, however, injurious in one case of fever, ac- 
companied with great pain in the spleen, increased at each access of pyrexia, 
and with a painful swelling" of the left foot. These disorders being- removed by- 
appropriate remedies, the prussiate of iron showed its accustomed efficacy. 
Many of those who were cured by the prussiate of iron had previously tried the 
pepper without benefit, so that the cure cannot be ascribed to the pepper 
which was contained in the above formula. — Hiifeland's Journal, June, 1828. 

The above affords a most gratifying" confirmation of the opinion expressed by 
our collaborator, Dr. Jackson, of Northumberland, of the efficacy of the prus- 
siate of iron in intermittent fevers. See his interesting" paper, Vol. II. p. 335. 

39. Method of Arresting the Bleeding from, Leech-bites. — The usual applica- 
tions for arresting the haemorrhage from leech-bites sometimes fail, and it be- 
comes necessary to resort to the actual cautery or ligature. S. RiDAi.ro, of Leg- 
horn, recommends a more simple means which he has found both safe and 
effectual. It consists in applying a cupping-glass to the wound, when a coa- 
gulum is almost immediately formed, and the bleeding arrested. This effect 
is very quickly produced, and has been found to take place even in children, 
and in persons where the mass of the blood appears to be in a state of dissolu- 
tion, and without any tendency to coagulation. The instrument may safely be 
removed within a few minutes, but it is prudent to let the coagulum remain 
for some time. — Repertorio di Medic, and di Chirurg. di Torino, July, 1828. 

40. Hydriodate of Potash as a Cure for Cynanche Parotidea. — Dr. Neumann 
employed the hydriodate of potash as an external application with great success 
in an epidemic cynanchea parotidea, which prevailed at Neustsedtel in June, 
1823. In the lower classes who were treated by the ordinary means, the dis- 
ease was very obstinate, and often terminated by suppuration. Among the 
richer classes the treatment consisted alone in the administration of an emetic, 
and the application to the swelling, of a plaster composed of eight parts of mer- 
curial ointment, and one part of hydriodate of potash. By these means a cure was 
always effected in three or four days, and Dr. N. says that in none of those treat- 
ed by this method did metastases occur to the other organs, which so frequent- 
ly happen in this disease, and he attributes this fortunate circumstance to the ap- 
pearance of an erythematic eruption which occurred on the first or second day, 
and which remained during eight or twelve days. — Rusfs Magazin, 1826. 

41. On Transfusion. — Dr. Dieffestbach of Berlin has made many experi- 
ments relative to transfusion; and he has found that if an animal be brought 
into a state of asphyxia by copious bleeding, it is not unfrequently restored to 
life by transfusion of blood from an animal of the same species; in most in- 
stances, however, it dies instantly, or very soon after the operation. Death al- 
ways ensued when, during the asphyxia, a considerable quantity of blood from 
an animal of another species was injected, even though the quantity of blood 
injected was very small, as was generally the case in these experiments. Some 
animals appeared to be more easily affected by a different blood than others; cats 
and dogs for instance, more than sheep. Cold blooded animals almost always 
died after the injection of the serum of blood from warm blooded animals. 
Birds seemed to be unable to bear even the smallest quantity of blood from a 
quadruped; they died instantaneously, and under the most violent convulsions. 
— Rust's Repertorium. 

42. Transfusion in a Still-born Child. — Dr. Dieffekbach relates the case of 
a child who was extracted by the Caesarian section, the mother having died 
during delivery. The child was in a state of asphyxia and bleeding; the warm 
bath and frictions failed recovering it. Two ounces of blood having been in- 
jected into the umbilical vein, some movements in the face were visible, but 
life was not restored. — Ibid. 



Practice of Medicine. 225 

43. On Bleeding in the cold stage of Intermittent Fever. — Dr. Stokes of Dub- 
lin, has investigated the utility of this practice, on an extensive scale in the 
wards of the Meath Hospital ; and he has published in the Edinburgh Medical and 
Surgical Journal for January last, the results of his investigations. These are 
certainly ag'ainst the indiscriminate or even frequent use of bleeding" in the cold 
stage of ague. In the great majority of cases, quinine had to be administered 
before the disease was eradicated; many of them had an extremely slow and 
dangerous convalescence; in several instances the disease, so far from being re- 
lieved, appeared«exasperated by the practice; and Dr. S. thinks that the bleed- 
ing appears to have a tendency to convert intermittent into continued fever. 
He says that in none of his cases did any bad effect from sinking of the powers 
of life follow the practice immediately; but that he is informed that in the prac- 
tice of a highly respectable individual, there occurred two cases in which the 
patients did not recover from the collapse produced by bleeding in the cold 
stage. 

Dr. Stokes also quotes extracts of letters from Dr. Kelly of Castlerea, and Mr. 
Gill of Nottingham Park, giving the results of their experience. The former states 
that he has found the general effect of bleeding in the cold stage, that of cut- 
ting short the rigor and rendering the hot stage generally milder and in gene- 
ral of rendering the disease more manageable by other remedies — but in some 
cases the disease has appeared to have been exasperated by the practice. The 
latter has employed the remedy in thirteen cases, and says he considers it not 
only useless but dangerous, when indiscriminately followed. They all, however, 
acknowledge that there may be cases in which it would be useful, but they do 
not designate the circumstances in which it should be employed. 

There is one curious objection brought against the practice by Dr. Stokes, 
which is, that it has a tendency to excite local inflammations. This we confess 
we cannot understand, and must believe that when such inflammations have 
supervened, they were a mere sequence and not a consequence of the bleeding. 

44. Itch cured by Chloride of Lime. — In Vol. II. p. 209, we mentioned that 
the chloride of lime had been recommended by Dr. Derheims, as a cure for the 
itch. It is stated in the London Medical and Surgical Journal, for November 
last, that Dr. Johnson of Linn, has cured a family of seven persons, affected by 
scabies papaliformis, by a bath formed of one part.ofFinchams' chloride of lime 
to six parts of water. They remained in the bath for ten minutes; this was re- 
peated daily for six days; the disease was not felt by the patients after the second 
application. 

45. On Brome as a cure for Scrofula and Goitre. — Dr. Pourciie has employed 
the brome in the treatment of scrofula and goitre, in two individuals of a lym- 
phatic constitution. The scrofulous tumours were dissipated by the use of fric- 
tions with an ointment containing hydrobromate of potash, or by the employ- 
ment of cataplasms sprinkled with a watery solution of brome. In a third case, 
an old and scrofulous engorgement of the testicles yielded to the use of the 
same means, with the internal administration of brome. An enormous goitre 
had lost two-thirds of its size, when Dr. P. published his observations. Dr. P. 
administers the brome internally, sometimes dissolved in water, in the form of 
hydrobromate. In the first case he dissolves one part of brome in fourteen parts 
of distilled water, and gives five to six drops in a portion of pure water, and 
gradually augments the dose. Of the hydrobromate of potash he gives from four 
to eight grains daily in pills. — Journ. de Chim. M6d. Dec 1828. 

46. On the treatment of Metallic Colic by Sulphate ofMumine. By M. D. Mox- 
taxceix. — For thirteen years M. Kapeler, physician to the Hospital Saint An- 
toine, in which every year from fifteen to twenty individuals affected with me- 
tallic colic are admitted, has treated this disease successfullv with sulphate of 

No. VII.— May, 1829. 29 



226 QUARTERLY PERISCOPE. 

alumine. M. Montanceix reports, in the November number of the Archives Ge- 
nerates de Medecine, ten cases cured by this remedy, in some of which the com- 
mon and unphysiological treatment by drastic purgatives, sudorifics, and nar- 
cotics failed. The dose of the sulphate of alumine is from one to two drachms 
in the twenty-four hours; one drachm is usually sufficient to commence with. 
It should be mixed with some mucilaginous emulsion, and a table-spoonful taken 
every hour, so that the requisite quantity may be taken in the twenty-four 
hours. Mucilaginous drinks and laxative enemas, were used as adjuvants in the 
cases reported. 

47. Transfusion in Hydrophobia. Dr. Dieffenbach, of Berlin, relate sin Rust's 
Repertorium a case of hydrophobia in which he has lately employed transfusion, 
but without any apparent effect. The patient was a middle aged man, who 
had been bitten four weeks before he was seen by Dr. D.; at this time he was 
tranquil, and fully conscious of his state, but the eyes had a somewhat wild ex- 
pression; the pupils were dilated; the pulse ninety-two, slow and intermitting, 
with two quick pulsations, full and sharp; he had burning thirst, but so violent 
a dread of water that the least attempt to drink caused convulsions. He had 
taken an emetic, and afterwards calomel with belladonna; but these means hav- 
ing no effect, and his state becoming worse, transfusion was resolved upon. 
After a bleeding of twenty-four ounces; twelve ounces of blood were, at two 
different periods, injected. At each injection the pulse rose and became re- 
gular, and after some time the dread of fluids seemed to diminish; in order to 
quench the violent thirst, a few ounces of water were injected into the sto- 
mach. In the evening the patient had some shivering, and was feverish; 
the pupils remained dilated, even in the strongest light. On the next day no 
change had taken place, only the dread of water, had again diminished; some 
ounces of the decoction of senista were injected into the stomach. He was 
bled to thirty-two ounces, after which twelve ounces were slowly transfused, 
but without any effect. On the following day, the patient had considerably 
changed; the face was pale, the eyes glassy, and the dread of water so violent, 
that he was taken with shivering only at the sight of it. In the afternoon, after 
a bleeding of six ounces, five ounces of blood were again injected; immediately 
after the operation the patient drank some water, but died an hour afterwards, 
in convulsions. 

Dr. Mayes, of St. Petersburgh, also relates in Hufeland's Journal, a case in 
which he employed transfusion, but with similar want of success. The patient 
was a man forty years of age, who had been bitten in May 1820, by a cat. The 
wound healed in four days. On the 19th of March 1821, he was tormented by 
a violent venereal desire, which, however, he did not satisfy, and in the evening 
he became morose, and had all the precursory symptoms of rabies, which first 
manifested itself on the 25th of May, by a violent shivering and a terror at the 
sight of the holy water, in a church. He was immediately carried into the hos- 
pital, and soon exhibited all the symptoms of confirmed hydrophobia. The 
contact of tepid water caused less shivering and convulsions than that of cold 
water, and there was no dread of bright surfaces. The cicatrix of the wound 
was scarified, and covered with a blister; five ounces of blood were taken from 
the arm; and, according to Magendie's plan, a pint of water, at 101 degrees, was 
injected into the cephalic vein of the right arm, during which operation the 
patient had a burning sensation in the left subclavian region: after it, the pulse 
fell from 90 to 60, and became very small. This injection of warm water was 
twice repeated in the space of about eight hours, and accompanied by nearly 
the same symptoms; the vein became, in its whole course, turgid and painful, 
and the patient complained of a very unpleasant sensation of heaviness in the 
region of the heart. At midnight a profuse perspiration came on, especially 
on the chest, without, however, being followed by any alteration in his state. 
On the 25th of May, the injection was repeated; to the dread of water, a per- 



Practice of Medicine. 227 

feet horror of wind, or any movement in the air, succeeded. At noon, he was 
prevailed upon to take some hot beer, of which he at last, by means of a long- 
tube, succeeded in swallowing three ounces; it was, however, soon brought up 
again. On the 26th, tepid water was injected a fifth time, but tetanic convul- 
sions supervened, and he died the same day. 

On examination, the pia mater was found much infiltrated; the substance of 
the brain hard and injected; the vessels of the pons Varolii and medulla ob- 
longata, particularly near the origin of the auditory, fascial, pneumogastric, 
glosso-pharyngeal and hypoglossal nerves, were gorged with blood; the arach- 
noid of the spinal chord was injected, and contained a serous effusion; the sa- 
livary glands were filled with a dark liquid blood. 

48. Pustular Venereal Eruption, treated by the Subcarbonate of Ammonia. — 
P. M. thirty-eight years old, emaciated, and of a very weak constitution, ob- 
served, in the month of July, a particular eruption on his forehead; this having 
been suppressed for a time, by a nostrum, the composition of which was un- 
known, soon returned again, with a tendency to form ulcers, and began to 
spread over the whole body. On his admission into the hospital, in September, 
under the care of M. Biett, he was in the following state: — Almost the whole of 
his body, but especially the inferior extremities, were covered with ulcerating 
pustules of different sizes; in the centre of each pustule there was a prominent, 
black, very hard crust, surrounded by a white ulcerating margin; the epider- 
mis round the ulcers presented a copper-coloured defined areola. In those pus- 
tules, where the crusts had been detached, the surface was excavated, much in- 
jected, and covered by grayish-white tenacious matter; the skin, between the 
pustules, exhibited livid blotches, the scars of former ulcers. The patient had, 
in 1814, successively been affected with gonorrhoea, chancre, and bubo, and 
had never had recourse to a proper mercurial treatment; he was married, and 
his wife, who had borne several healthy children, had never presented any signs 
of infection. His general health was good. 

M. Biett, having for some time employed cinnabar fumigations, and the al- 
kaline bath, prescribed the subcarbonate of ammonia, from the use of which, 
he had, in similar cases, observed very satisfactory effects; the patient took a 
drachm daily, and this, being borne very well, and without the least disturbance 
of the digestive organs, the dose was afterwards increased to two, and even to 
three, drachms. The crusts were gradually detached, and the excavated ulcers 
became more superficial, and assumed a healthy appearance; so that the pa- 
tient, after having used the subcarbonate of ammonia for twenty days, was per- 
fectly cured. — Journal Hebdomadaire de Medecine* 

49. Psoriasis Inveterata, successfully treated by the Arsenical Solution. — Xav. 
Host, setat 39, of a vigorous constitution, was, on the 7th of September, admit- 
ted into the hospital, under the care of M. Biett. Having, up to his eighteenth 
year enjoyed good health, he observed at this period, without any previous 
cause, a scaly eruption on his legs and thighs; the scales were very small, dry, 
of a whitish colour, and slightly adherent to the skin, from which they were de- 
tached by the least friction, leaving some elevation and redness. In this state 
the patient continued for several years, without any disturbance of the consti- 
tution; sometimes, especially in winter, the eruption disappeared entirely; but, 
on returning, it insensibly extended over the whole body, and the scales began 
to change into thick crusts, which were firmly attached to the skin. During the 
last three years he had been much addicted to drinking, in consequence of 
which the disease had become so serious as to induce him to seek for medical 
aid. When admitted into the hospital he had, for the last six months, been in 
the following state: — The whole body, with the exception of the parts exposed 
to the air, and the genitals, was covered with large, irregularly oval crusts, of dif- 
ferent thicknesses; their surface was beset with white scales, which, according to 
their longer or shorter standing, were more or less firmly attached to the parts 



22S QUARTERLY PERISCOPE. 

beneath. The skin over the joints, and of the thighs, was covered with very 
thick, rigid crusts, with large furrows filled by a bloody ichorous matter, so that 
the patient was almost entirely deprived of the use of his limbs. His general 
health was not affected, his digestion was good, &c. After a bleeding of ten 
ounces, and the use of some aperients, M. Biett prescribed the arsenical solu- 
tion, of which the patient took four drops daily, and this dose was afterwards 
gradually increased to twelve drops. The effect on the cutaneous disease was 
astonishing; the crusts, which before had been remarkable for their rigidity and 
torpid appearance, gradually detached themselves from the skin, leaving, at 
first, large red blotches, which were again covered with scales, but after re- 
peated desquamation the integuments gradually assumed their natural colour 
and appearance, so that it was found unnecessary to continue the use of the me- 
dicine for more than four weeks, after which period, the vapour bath having 
been employed for some time, the patient was perfectly cured. — Ibid. 

50. Incipient Paralysis cured by Bleeding from the Arm. By M. Brqttssais. — 
A gentleman aged sixty-five years, who had been for many months subject to 
vertigo, whilst walking; after returning home on the afternoon of the 29th of 
July, without having breakfasted, felt himself much worse; and on taking a seat 
he fell down, a circumstance which he did not afterwards remember. He was 
put to bed, when he commenced to stammer, his speech was embarrassed, his 
mouth a little turned to the left, his right limbs most feeble. The nearest phy- 
sician was sent for, who ordered an infusion of linden, and orange flower water. 
M. Broussais saw the patient in the evening, and found him affected with diffi- 
culty in speaking, dullness, imperfect memory, slight distortion of the mouth, 
slight inflection to the tongue to the right side; great feebleness, and also torpor 
of the right limbs; face very much flushed; pulse small, feeble, and slow. Dr. 
B. had him bled about twenty ounces, which produced a little faintness, but he 
spoke better. Ordered lemonade with privation of all food. The next day the 
patient was wonderfully better, spoke with his usual volubility, enjoyed all his 
faculties, was a little weak only, had a good appetite. 

If we ask, says Dr. B. why the physician who was first called to see the pa- 
tient had not at once recourse to bleeding, we will find that he had in view 
but to remedy a nervous state considered in a vague manner, there was some- 
thing wanting to the group of symptoms which he considered as indicating a 
sanguineous congestion in the brain, there was wanting a strong and full pulse. 
These being absent, he considered it merely as a nervous state to which he 
opposed the linden and orange flowers, until the entity disease had assumed all 
the characters, of which it had out of malice omitted the most important. — 
Annates de la Medecine Physiokgique, Sept. 1828. 

51. Treatment of Hydrophobia with Chlorine. — MM. Semmola and Schoek- 
berg are said to have employed chlorine in the treatment of hydrophobia, with 
success. It is used in the following manner: the wound is to be washed as soon 
as possible with the chlorine in water, and afterwards covered with lint impreg- 
nated with the solution, and this treatment is to be repeated twice a day till the 
wound cicatrizes; but if the wound does not heal by the end of five days, it is 
then to be treated in the ordinary manner. If the wound has healed before em- 
ploying the chlorine, it is to be cauterized with the butter of antimony, and 
when the eschar separates the lotion is to be used. During the first five days, 
the chlorine is to be given also internally, in doses of two drachms in an ounce 
of sweetened water, three times a-day. Care should be taken in its administra- 
tion, for if given in too large doses, or not diffused in a sufficient quantity of 
water, it will be injurious. — Bulletin des Sc. Med. July, 1828. 

52. Fumigation of Belladonna in Phthisis Pulmonalis. — Professor Cruveil- 
uier has employed for some time, with success, in the treatment of phthisis 
pulmonalis, fumigations with the leaves of belladonna previously dipped in a 



Practice of Medicine. 220 

strong solution of opium and partially dried. The patients commence by smoak- 
ing two pipes a day, and gradually increase the number till five or six are used 
in the same period. In eight patients upon whom the remedy has been tried, 
some in the second and others in the third stage of the disease 5 in the former 
the cough was rendered much less frequent, and no longer prevented sleep, 
the irritation of the larynx was removed, the dyspnoea diminished, the expecto- 
ration less abundant, the fever lessened, and the emaciation arrested; in the 
latter the sweats were less frequent and less abundant, heat lessened, expecto- 
ration facilitated, colic and diarrhoea assuaged, fever restrained, finally, it may 
be said that the disease is arrested. — Nouv. Bibl. Mid. Sept. 1828. 

53. New Mode of Treating Taenia, discovered by Dr. Schmidt, of Berlin, and 
described by M. Caspah, by order of the Prussian government. — On the 14th of 
October, 1823, Dr. C. A. Schmidt, of Berlin, announced to the minister of pub- 
lic instruction, and medical affairs of Prussia, that he had, twenty years since, 
discovered an infallible remedy for the tape-worm, and was desirous of selling 
his secret to government. The minister directed Dr. Natorp to make trials 
with the practice, and, in a report made the 25th of July, 1824, this physician 
pronounced the treatment of Dr. Schmidt to be excellent; that it was adapted 
to the most feeble constitutions; brought away the tape-worm within twenty- 
four hours at furthest; called for no previous preparation, and caused no more 
exhaustion than a common purgative. Messrs. Kluge and Neuman, physicians 
to the hospital of La Charite, at Berlin, were commissioned to repeat these ex- 
periments. In the report made by these gentlemen, on the 31st of October, 
1826, they express themselves thus: — "The method of M. Schmidt never 
failed in its effects when the presence of the taenia was established, and in those 
cases wherein it failed to produce the evacuation of a worm, the existence of 
this was regarded as doubtful. At the same time, the treatment is prompt, 
without danger or exhaustion, and the worm is expelled entire and alive." In 
consequence of the report made him by the minister, the King of Prussia 
granted Dr. Schmidt, on the 31st of March, 1827, a pension of one hundred 
and fifty dollars for the publication of his remedy, which he described as fol- 
lows: — First day the patient takes in the morning, fasting, two-spoonsful of the 
following preparation, and the dose is to be repeated every two hours till seven 
o'clock in the evening. 

No. 1. Take powder of valerian root, six drachms; sense leaves, two drachms; 
make into an infusion of six ounces, to which add sulphate of soda, three 
drachms; syrup of manna, two ounces; oil of tansy with sugar,* (oleo-saccharum 
de tanaisie,) two drachms. Mix. 

The patient drinks coffee made very sweet, and without milk; at noon plain 
soup with some morsels of herring-, and the roe of this fish; at eight o'clock in 
the evening a salad made of herrings, raw ham sliced, one onion, with a consi- 
derable quantity of oil and sugar. The patient most commonly expels, even on 
the first day, some portion of the tape-worm. In two cases M. Schmidt has 
even seen the worm evacuated whole from this preliminary treatment alone. 
The second day the patient takes every hour, beginning at six o'clock in the 
morning, the following pills: — 

No. 2. Assafoetida, dogs-grass, (chiendent,) each three drachms; powdered 
gum gamboge, rhubarb and jalap, each two drachms; powdered digitalis, ipe- 
cacuanha, golden sulphuret of antimony, each twelve grains; calomel, two scru- 
ples; oils of tansy-|- and anis, each fifteen drops. To be made into amass, and di- 
vided into pills of two grains each, which are to be kept in a well-stopped bottle. 

These pills are taken with a tea-spoonful of syrup. Half an hour after the 
first dose, the patient takes a table-spoonful of castor oil, and through the day 
drinks freely of coffee well sweetened. In most instances the worm is evacu- 
ated about two o'clock in the afternoon, in which case the pills are to be stop- 

* This is prepared by adding twenty-four drops of oil of tansey to one ounce of loaf-sugar, 
t Obtained by distillation of the fresh plant. 



230 QUARTERLY PERISCOPE. 

ped; but where, on the contrary, only fragments of the taenia are passed, these 
pills are to be continued along- with which a spoonful of castor oil with sugar is 
to be given from time to time: the treatment is to be discontinued whenever 
the evacuations cease to contain any of the worm. At noon the patient takes 
nothing but broth, and in the evening some soup with fresh butter and sugar. 
To make sure that, (to use the author's mode of expression,) no more of the nest 
of the taenia remains, the patient may still take some of the pills in the morning. 
To prevent relapses, the patient ought occasionally to eat herring salad and 
horse-radish with vinegar and sugar; or, otherwise, he should continue for some 
time to take, about every eight days, one or more doses of the pills. When 
the treatment is finished, the patient is allowed to eat gruel, young meats, 
chicken, pigeon, the yolks of eggs, good wine in small quantity, and some 
kind of bitters. 

Where it is not certain that tape worm exists, the following method of ascer- 
taining its presence or absence is adopted. The patient eats herring salad in 
the evening, and drinks freely of sugar and water; the following morning he 
uses the following powder in syrup: take powdered jalap, gr. xv. wormseed, gr. 
x. gum gamboge, calomel, aa. gr. vi. oil of tansy, (oleo-saccharum,) gi. After 
this powder, the patient drinks coffee made very sweet, or very fat broth. The 
powder produces copious alvine evacuations, and if the patient be affected with 
taenia, joints of it, or sometimes the entire worm, will appear in the stools. In 
this last case, the pills are to be followed up by the treatment No. 2, for the 
purpose of establishing a complete cure, should there be more than one taenia. 

Dr. Schmidt does not employ his treatment during pregnancy, nor immedi- 
ately before or after the menstrual period, nor with individuals affected with in- 
flammations, phthisis, marasmus, haemorrhoids, haemoptysis, or senile debility. 

Of one hundred and sixty-six persons cured of taenia by Dr. Schmidt, but 
fifteen were men, twenty had but one taenia, and all the others more, one eva- 
cuated as many as seventeen. After the publication of Dr. Schmidt's treatment, 
the experiments were repeated at the Hospital of La Charite, in Berlin, with 
constant success, as shown by the six cases which close the memoir. — Archives 
Generates, January, 1829, from Hufeland's Journal, August, 1828. 

54. Neuralgia Facialis. — The Osservatore Medico di Napoli, No. 18, contains 
an account by Dr. Campagno, of a case of neuralgia facialis which was cured by 
the vinous tincture of colchicum. A multitude of remedies had been previous- 
ly tried without effect, 

55. Dysentery. — Dysentery has recently prevailed to a considerable extent in 
the Edinburgh Infirmary. The treatment adopted by Dr. Christison, " consist- 
ed at the commencement in the liberal use of opium, preceded in some in- 
stances by the free application of leeches to the lower part of the belly, and 
frequently accompanied with the application of large blisters, and with the use 
of the warm bath. If the stage was passed during which feculent matter was 
discharged, and the evacuations had become muco-sanguinolent or sero-sangui- 
nolent, I usually directed the application of the leeches to be immediately fol- 
lowed by doses of pure opium, of such magnitude and frequency as were found 
necessary to check the unremitting diarrhoea and tormina; and sometimes the 
desired effect was not procured till the patient was pretty strongly affected by 
the narcotic action of the drug. In urgent cases twenty or twenty-four grains 
in the twenty-four hours were sometimes necessary from the very beginning; 
in the slighter cases four or six grains were sufficient. When an impression was 
once made on the discharges, it was maintained by doses of two or three grains 
repeated according to circumstances; and frequently the exhibition of opium 
by the mouth was conjoined with its employment in the form of suppository. 
I never but once found this plan to fail in checking the discharge of blood in 
twenty-four or forty-eight hours, if the patient was seen within three or four 
days; but the blood often reappeared abundantly in the stools, if the opium was 



Ophtha Imology. 231 

intermitted on account of its causing too complete constipation. After the 
haemorrhage was permanently checked, the frequent thin feculent stools con- 
tinued many days, sometimes many weeks, indicating, it is to be presumed, the 
existence of ulceration, which consequently must have taken place at a very 
early period of the disease. The opium, it is worthy of remark, rarely caused 
sickness or dry tongue. In cases in which the stools continued long thin, and 
with a tendency to be tinged now and then with blood, an opportunity occurred 
for trying various remedies which have been supposed to be useful in this stage 
by accelerating the cicatrization of the ulcers. But I cannot say that any of them 
appeared to be of use, unless opium was combined with it in such quantity as to 
be itself a powerful agent. The acetate of lead was perhaps an exception; it 
certainly rendered the stomach less irritable, in the few cases in which opium 
alone was rejected by vomiting; and although I had too few opportunities of 
trying it in idiopathic dysentery, the experience I have had in the Fever Hos- 
pital and Infirmary fever-wards of its good effects in the chronic dysentery 
which is sometimes left after fever, induces me to think that its alleged virtues 
in the chronic stage of idiopathic dysentery have not been exaggerated. Nei- 
ther ipecacuan, nor nitric acid, nor calomel administered so as to affect the 
mouth, appeared to me materially useful. I have had but one opportunity of 
trying the effect of calomel in scruple doses upon the early stage of the disease. 
It was given on the fourth day with marked advantage certainly, and was re- 
peated next day with equally good effect. But ulceration had evidently taken 
place before the patient came under my charge; and although the acute symp- 
toms were checked, yet, as the patient was an emaciated subject transferred 
from the surgical wards with a recently-opened, extensive, chronic abscess, he 
sunk under the exhausting purulent discharge from the bowels and abscess to- 
gether. The only Other patients I lost were two in number, — one an old man 
of ninety, who entered the hospital on the eighth day of his illness in a state of 
extreme exhaustion, so that, although the stools were checked, he died two 
days afterwards, — the other, a young woman, who immediately after coming 
out of an exhausting and tedious attack of continued fever with marked enteri- 
tic symptoms, was seized with dysentery in its worst form, and died on the 
tenth day without experiencing any relief from treatment beyond the allaying 
of pain."— Ed. Med. and Surg. Journ. Jan. 1829. 



OPHTHALMOLOGY. 

56. Complete Amaurosis cured by the application of Leeches to the Nasal Fossae. 
— Dr. Gitepiket of Landrecies, relates in the Annates de la Medecine Physiolo- 
gique, Vol. X. the case of a child aged five years, who was suddenly attacked 
with complete amaurosis, without any known cause. The disease resisted the 
usual remedies for nearly two months and a half, when Dr. G. being consulted, 
he advised the application of leeches to the nasal fossx. The day after their 
application the child was able to see a little; thus encouraged, Dr. G. had one 
or two leeches applied daily for a week, at the end of which period the child's 
sight was entirely re-established. 

57. Singular Tumour in the Eye successfully extirpated. By H. Clarke, Esq. 
— The subject of this case was a Hindoo, aged four years. A tumour nearly 
globular, and of the size of a common orange, projected from the left orbit. 
" This enormous excrescence was firm and tense to the touch, and presented 
anteriorly a granulated surface of a florid aspect. Its posterior circumference 
was of a dusky hue, and was covered by a shining membrane. On its anterior 
superior portion was situated the protruded eye, compacted into an unyielding 
fibrous mass, of an irregular oviform figure, apparently destitute of the slightest 



232 QUARTERLY PERISCOPE. 

vestige of its previous organization. The superior and inferior palpebrx were 
distended to their utmost limits by the tumour, which, from its firm attachment 
to them, had dilated the integuments to a considerable extent, in its gradual 
progress from the bony cavity. The history of this case is involved in ob- 
scurity." 

Mr. Clarke being satisfied of the necessity of extirpating this tumour, pro- 
ceeded to the operation June 26, 1826, assisted by Mr. Thompson, who grasp- 
ed the tumour, whilst Mr. Clarke " detached the adherent eyelids, and dissect- 
ed the tumour from its firm attachments in the bony cavity. It was so firmly im- 
bedded in the socket, that a little patience was required in order to insinuate 
the scalpel with effect. As the dissection advanced toward the base, the com- 
pact structure which invested the tumour gradually merged into a softer sub- 
stance; which, when in contact with the remains of the orbit or vessels, termi- 
nated in a pulpy mass, partaking of the character of the tumour, which more 
nearly resembled the medullary sarcoma of Abernethy than any other species. 

In substance it was exceeding like a portion of brain, of a dark, dusky hue. 
A small quantity of matter, of the consistence of thick cream, and in colour of 
a red tinge, escaped from a depending part, on an incision being made. The 
disorganized eye was converted into a homogeneous mass of a fibrous nature, 
retaining only in its posterior portion any traces of its former character: in this 
part a fragment of the sclerotic with the choroid coat, could be distinctly traced. 
The tumour being removed, its place was filled with lint, and the eyelids again 
brought into contact; a compress was now applied, and the whole supported 
by a bandage. — 23d. On removing the dressings this morning, the cavity of the 
orbit presented a healthy purulent secretion. Renewed the application of dry 
lint. — 26th. Healthy suppuration appears to be established; the bottom of the 
orbit is covered with yellow consistent pus. Care was taken to fill the cavity 
with lint, as formerly. — 29th. This morning appearances continue perfectly 
healthy. 

" The above tumour, in a modified sense, may be considered as encysted, 
the adjacent cellular substance being condensed into an investing membrane 
of considerable tenacity. A portion exterior to the palp ebrse, and also within 
the cavity, was enveloped by it. As observed above, the covering was gradu- 
ally lost in the medullary substance at the bottom of the orbit, where the re- 
mains of the recti muscles existed, unaltered in their structure. Some venous 
blood escaped from the turgid vessels, on making the first incisions, but sub- 
sequently the haemorrhage was trivial." — Transactions of the Medical and Phy- 
sical Society of Calcutta, Vol. III. 

58. Case of Fungous of the Globe of the Eye successfully extirpated. By Wl 
Twining, Esq. — " A healthy, but rather slight made Hindoo, about fifty years 
of age, applied at the Eye Infirmary on the 17th February, 1 826, having a fun- 
gus that protruded from between the right eyelids, larger than an egg: it was 
of red colour, hard, and its surface irregular or granular, like a firm cauliflower, 
and when handled or pressed, there was little bleeding, but always a puriform 
discharge. 

" The tumour appeared to grow from the whole of the eyeball; it wasmove- 
able, and the base was firmly girt by the eyelids, but not attached to them: in 
fact there was no very strong attachment apparent, except at the lachrymal 
gland. It filled the whole front of the orbit, and protruding, as above stated, was 
not only a hideous deformity, but was productive of severe pain in the orbit and 
head. The weight and pressure of the protruded portion of the tumour which 
rested on the cheek, had there caused ulceration of the skin. The disease had 
been fourteen months in arriving at this state, and was preceded by inflamma- 
tion, which the man said arose from a particle of straw blown into his eye by 
the wind. 

" On the 5th of March I extirpated the disease with a common scalpel. The 



Surgery. 233 

base of the tumour was so firmly girt by the aperture of the eyelids, that an in- 
cision was first requisite from the outer corner of the eye towards the temple, 
so as to give more room for the operation, which was then accomplished in less 
than a minute by a few strokes of the knife. Two arteries bled freely; and were 
secured by ligatures. A piece of lint was placed over the closed lids, and over 
that a sponge retained by a bandage. 

" There was no unfavourable symptom afterwards, and the patient was dis- 
charged cured at the end of the month. This man presented himself at the Eye 
Infirmary a few days ago, (February, 1827,) remaining quite well, and there 
does not appear any tendency to a return of the disease. 

" After the operation, on making an incision across the tumour, it was found 
of a firm granular texture throughout; and in its centre the remains of the eye 
were very evident. The whole globe of the eye, with a portion of the optic 
nerve, were removed, as may be seen on inspecting the preparation, which is 
now at the Eye Infirmary. 

"On maceration in spirit, the tumour became of a white colour, and shrunk 
to about half its original size: but still the shape of the eyeball is distinctly 
marked by the pigment of the choroid,"—/^. 

This case is interesting, as showing that some tumours of very formidable ap- 
pearance, and productive of severe pain, have nothing in their nature which is 
malignant, and may be extirpated with success. 



SURGERY. 

59. Wound of the Femoral Artery successfully treated. By M. Lisfrakc. 
— M. T. aged twenty-three, sanguine temperament, excellent constitution, 
violent character, seized, during a fit of passion, on the 3d of June, a 
knife, nine inches in length, and ran it through his thigh from side to 
side. The blade penetrated from without inwards, about two-thirds up the 
thigh, and came out about an inch above the aponeurotic ring through which 
the femoral artery perforates the triceps muscle. The haemorrhage which in- 
stantly came on was frightful; his strength forsook him, and he fell down on 
the pavement, before he could aim another blow at his heart, which he 
attempted. He was immediately conveyed to the Hospital de la Pitie", and 
placed on a bed. This was at five o'clock in the afternoon. Drs. Devil- 
liers and Salone, who arrived a few minutes after the accident, exercised suc- 
cessively with M. Martinet, the eleve of the hospital, strong pressure on the 
artery, just below Poupart's ligament. The patient was seized with vomiting, 
which rendered compression very difficult; the accident took place immediate- 
ly after his repast. M. Lisfranc arrived at ten o'clock, and found the patient 
in the following state: — Constant vomiting', starting of the tendons, syncope, 
extreme pallor and sinking of the countenance, the wounded member was 
nearly double its natural size, but the colour of the skin was not changed. It 
was a question whether the enlargement of the limb was caused by the injec- 
tion of blood into the cellular membrane, or by inflammatory tumefaction. M. 
Lisfranc considered it to be the latter, as he had before witnessed cases where 
inflammation and tumefaction came on in the course of an hour or two, con- 
trary to the opinion of most authors; he therefore acted upon the strength of 
his diagnosis, and proceeded to tie the vessel. He made an incision three 
inches and a half in length by the side of the wound, commencing half an inch 
below the opening through which the artery perforates the tendon of the tri- 
ceps muscles. The subcutaneous cellular tissue was double its natural thick- 
ness, but there was no sanguineous infiltration. Having exposed the sartorius 
muscle, which was found swelled, the operator met at its inner edge the course 
of the wound, near the opening of the tendon of the triceps. The tissues were 
of a dark colour at this point, and slightly infiltrated with blood. The sartorius 
No. VII.— May, 1829. 30 



234 QUARTERLY PERISCOPE. 

had contracted intimate adhesions with the subjacent parts, owing to the in- 
flammation of the tissues. These adhesions were destroyed with the finger. 
Under the muscle, at the point where the vessel had been wounded, were 
found dense clots of blood. The sheath of the artery was next laid open to 
some extent, and the vessel was found contracted to a very small size, being 
quite empty. The vein, on the contrary, was very large, and its volume sin- 
gularly augmented every time the patient exerted himself in vomiting. Owing 
to the contracted state of the artery, the wound in its coat was so much reduced 
that M. Lisfranc could not discover it until the pressure above was removed for 
an instant. When the vessel was set at lib erty, the blood was immediately 
thrown out in a very thick column, and with great force. The operator instant- 
ly clapped his finger on the wound, and the pressure was renewed. A ligature 
was now passed under the vessel, which was tied above the wound. Another liga- 
ture was applied below it, but it was necessary before this could be done, to slit 
the tendon, through which the artery passes, to the extent of about a third of 
an inch. The wound caused by the operation was then closed, and its edges 
kept together by adhesive plaster, over which a compress was applied; then a 
bandage was twisted round the limb all the way from the crural arch to the toes. 
From eleven o'clock at night until the following morning the patient felt very 
severe pain in the inner ankle and instep; great tumefaction of the whole limb; 
no sleep. At seven o'clock, it was found necessary to slacken the bandage; the 
pain immediately abated. (~Gum-water,- absolute abstinence. J 

June 4th. Until four o'clock, slight pains towards the extremity of the mem- 
ber, which was placed in the demi-flexion on its outer side. The limb was 
covered with a bolster, for preserving its warmth; its natural temperature never 
forsook it. Vomiting intermittent, and without any effort; a few minutes sleep 
in the day. Towards ten o'clock at night, slight delirium; pulse full and fre- 
quent; skin hot; but as the patient had lost a great quantity of blood, it was not 
judged proper to have recourse to bleeding. At intervals, during the night, 
the patient had about three hours sleep. ( 'Same prescription. J — 5th. He slept 
during the whole night; the suppuration which commenced to be established 
was of a good quality, and it issued in great abundance from the outer wound 
caused by the knife. The heat of the limb was natural. (~ Gum-water,- absti- 
nence,- dressings renewed twice a-day.J 

The patient was kept under a similar treatment until the 14th, when he was 
allowed chicken broth in addition. The wound continued to discharge very 
profusely for some days, but by the 17th, the discharge had nearly ceased. His 
diet was gradually increased from the last mentioned period; and by the 30th, 
he was perfectly recovered, and able to return to his occupations. The limb 
never lost its natural temperature. The lower ligature came away on the 13th, 
and the upper on the 14th. 

" There is one circumstance well worthy of notice in this case, namely, the 
sudden manner in which the inflammation and tumefaction of the limb took 
place in a case of clean incised wound. We cannot help noticing- also the fa- 
vourable and rapid cessation of the swelling, when neither surgical nor medi 
cal means were resorted to for their reduction. All the medicine which the 
patient took was gum-water. Not a grain of cathartic medicine of any sort was 
administered; nor is there a word said about the state of the bowels." — Lond. 
Med. and Surg. Journ. October, 1828. 

60. Stricture of the Urethra cured by a Mercurial Treatment. By Professor 
Graefe.— A man who had had gonorrhoea several times, was troubled for ele- 
ven ye#rs with stricture of the urethra, which was latterly so considerable as to 
produce a development of tumours along the passage, extending throughout 
the perinaeum. He felt a constant inclination to make water, but the fluid only 
came drop by drop, in consequence of which the bladder was never completely 
emptied. The absorption of the urine had affected the constitution of the pa- 
tient very much, and it communicated to the breath and perspiration a strong 



Surgery* 235 

urinous odour. When the patient entered the hospital, his suffering was in the 
extreme; the tumours had enlarged to such a degree that he had not been able 
to pass any urine for eight-and-forty hours. At this time he had a violent fever; 
the inflammation which supervened in the bladder and the scrotum had resisted 
blood-letting, general and local, and part of the urine had become extravasated 
into the surrounding cellular tissue through an opening which had formed be- 
hind the stricture. The puncture of the bladder, performed immediately, owing 
to the impossibility of introducing the catheter, removed the danger for the 
moment. The fever and the inflammatory symptoms abated under the use of 
appropriate internal remedies; but a considerable part of the scrotum had be- 
come gangrenous, and when the slough separated, a great quantity of urine, 
which had been extravasated, came away at the same time. In this state of 
things, and considering especially the original cause of this inveterate affection, 
mercurial frictions were prescribed. Under the influence of this treatment, the 
urethral tumours disappeared; the testicles, which were before naked, became 
enveloped in skin; the urinary fistulse closed, and the patient quitted the hos- 
pital. — Institut. de Clinique Chirurg. de Berlin. 

61. Case of Strangulated Hernia presenting a Remarkable Peculiarity. — Dr. 
Ehekmann, of Strasbourg, relates in the Repertoire de Anatomic, Vol. V. the case 
of a labourer, aged forty-seven years, of a robust constitution, who, some days 
after having entered the clinic of the faculty, to be treated for a whitlow, was 
attacked suddenly, without any known cause, with all the symptoms of stran- 
gulated inguinal hernia. The stricture was not produced, however, by the ex- 
ternal inguinal ring; for this permitted the introduction of two fingers, and the 
portion of tumour behind it was distinctly felt. Three days being spent in 
fruitless attempts at relief, it was determined to operate; but the precise seat 
of the strangulation was still doubtful: the external inguinal ring was free, the 
hernial tumour had the direction of the canal, and it could not be ascertained if 
it extended very far into the abdominal cavity; nevertheless, as the hernia was cir- 
cumscribed at the exterior, and it could not be reduced, Dr. Ehermann supposed 
that the stricture existed at the internal opening of the inguinal canal. An incision 
of three inches laidbare the aponeurosis of the external oblique, about an inch 
above the ring. On removing the fascia of condensed cellular tissue, the hernial 
sac presented, which was opened, some reddish serum flowed out, and the fold 
of intestine appeared of a livid colour, bluish, and inflamed throughout. On in- 
troducing the finger into the bottom of the wound at the superior angle, the 
supposed stricture at the internal opening of the inguinal canal, was immedi- 
ately recognised. The first finger of the left hand being placed on the intes- 
tine, and introduced to the seat of the stricture, served as a guide to Cooper's 
probe-pointed bistoury: immediately on dividing the stricture above and out- 
wards, the finger could be introduced into the cavity of the abdomen, and the 
fold of intestine was very easily reduced. The wound was dressed with adhe- 
sive plasters, lint, compresses, and bandages, and in less than a month the pa- 
tient was dismissed cured. 

Dr. Dorsey, in his Elements of Surgery, relates a case somewhat similar; but 
in it the stricture was produced by the neck of an old hernial sac, which had 
been a long time returned into the abdomen. 

62. Cases of Laryngitis, in which Bronchotomy was successfully performed. By 
Dr. Coupeb, of Glasgow. — " Case I. A weaver, fifty years of age, was admitted 
on the 7th of November, 1827, with dyspnoea, and difficult deglutition. The 
voice was much impaired — the air during inspiration produced in its passage 
through the upper part of the larynx, a loud, moving noise, and, at times, a 
ringing sound — occasional paroxysms of violent cough, with copious but diffi- 
cult expectoration of tough and yellow sputum — parts in front and at the side 
of the thyroid cartilage swollen and tender upon pressure, the swelling extend- 
ing in a less degree towards the cricoid cartilage and os hyoides — no discolora- 



236 QUARTERLY PERISCOPE. 

tion of the skin — nothing unusual in the fauces or the epiglottis — pulse 120, 
feeble, and thready— skin cold — aspect pale and haggard— strength much re- 
duced. These were the symptoms, and it seemed that six weeks before, with- 
out obvious cause, the complaint began by swelling around the thyroid cartilage, 
followed by throbbing pain in the part. In the course of seven days the pain 
was relieved, but difficulty of breathing and swallowing commenced, and during 
the last eight days had been urgent. 

"Leeches, and after them a blister, were immediately applied over the larynx, 
and a grain of calomel and the same amount of opium ordered to be taken every 
third hour. At nine, P. M. he was suddenly seized with dyspnoea so severe as 
to threaten immediate suffocation, and this was still so urgent when Dr. C. ar- 
rived, that he forthwith proceeded to open the windpipe. On account of the 
swelling above the larynx, the opening was made below the cricoid cartilage, 
which procured instantaneous relief for the dyspnoea. The wound was kept 
open by a bit of curved wire. No further difficulty of breathing took place, ex- 
cepting that once a severe fit of coughing was caused by a little milk escaping 
through the wound. On another occasion, also, accidental derangement of the 
wire produced a slight paroxysm, but further than these, not the slightest in- 
convenience was felt after the operation. After a few weeks the wire was ex- 
changed for a curved silver tube, about two and a half inches long, and one 
fourth of an inch in diameter, provided with two small rings, through which a 
piece of tape was passed, and tied round the neck, to retain the tube in situ. 

" 'On the supposition that the contraction of the cavity of the larynx depend- 
ed on thickening of its lining membrane, a mercurial course was prescribed, but 
apparently without benefit; for, although the patient contiued to breathe easily 
so long as the wound was kept open, yet all attempts to make him breathe 
through the mouth alone, proved ineffectual. On various occasions the wound 
was closed with adhesive plaster, to ascertain if any improvement had taken 
place, but it was invariably found necessary at the end of a few minutes to open 
the wound and replace the tube, on account of increasing dyspnoea. At one 
time I entertained hopes of being able to dilate the contracted larynx, by bou- 
gies passed upwards through it from the wound; but the extreme irritability of 
the parts rendered this proposal impracticable. The introduction of even a 
probe through the wound into the larynx, was found to excite such a paroxysm 
of cough, that it was absolutely necessary to desist.' 

"After remaining in the hospital above five months, the patient was dismiss- 
ed, suffering no inconvenience except the necessity of breathing through the 
tube, a circumstance which habit had rendered very tolerable. By stopping 
up the tube with the point of his finger, he could speak in a hoarse but audible 
tone. In the month of August last he appeared at the infirmary, and was per- 
fectly free from all complaint. 

Case II. — " This was a tobacco-pipe maker, aged twenty-eight, who was seen 
by Dr. Couper, thirteen days after the commencement of the laryngeal inflam- 
mation. He had been bled pretty freely at different times, blistered, and treat- 
ed with diaphoretic medicines, but still, though at times apparently relieved, 
the disease had proceeded on its march. When examined by Dr. C. he was 
just recovering from a fit of alarming orthopnoea, and presented these symp- 
toms. Incapability of assuming the horizontal posture — inspiration laborious 
and wheezing — fauces red and swollen — epiglottis enlarged, tense, and shaped 
like a glans penis during erection — uneasiness decidedly referred to the larynx. 
" * Laryngotomy was immediately agreed upon. In making the incision 
through the integuments, a small artery was cut, and bled very freely. At the 
same instant the dyspnoea became greatly increased; the patient's face became 
livid, his limbs quivered, and his urine was ejected involuntarily. Without 
waiting to secure the artery, I immediately perforated the thyro-cricoid mem- 
brane, and the transition from the state now described to easy respiration was 
nearly instantaneous. The patient's body being inclined forward, no inconve- 
nience was felt from the bleeding, which was speedily stopped by the pressure 
of the wire employed to dilate the aperture. From this time he continued to 



Surgery. 237 

breathe easily, partly by the wound and partly by the mouth, and swallowed 
without difficulty/ 

"Four days after the operation the wire was withdrawn, and on the 15th the 
wound was so very nearly healed that even during coughing no air escaped by 
it. Nine days after this, the patient had a rigor, followed by urgent orthopnea, 
and a little pain and swelling of the right side of the larynx. After vainly em- 
ploying a full dose of laudanum and antimonial wine, without relief, the larynx 
was opened a second time. In the course often days, the wire was changed 
for a silver tube which was kept in the wound for upwards of a month, and then 
withdrawn, shortly after which the wound was healed. A few days after this 
he was discharged, affected with only a glandular swelling on the left side of 
the neck, which soon disappeared on his leaving the hospital. 

" 'Both of these cases appear important; the former as an example of contrac- 
tion of the larynx produced by chronic inflammation, and the latter as an in- 
stance of the same effect arising from acute cedematous laryngitis. The im- 
portant fact, that the dyspnoea in cases of laryngeal disease is liable to sudden 
and dangerous exacerbations, is well illustrated by both. Such paroxysms may 
cease after the irritability of the parts is exhausted, but they will certainly recur 
again and again, until suffocation is produced, unless an artificial opening is made 
into the windpipe, to allow a free access of air to the lungs. When the ne- 
cessity for it ceases, the aperture can be easily healed up; and even should the 
contraction of the larynx prove permanent, as in the case of Limpitlaw, it must 
be allowed that the inconvenience arising from breathing through a tube in- 
serted into the windpipe during the remainder of life, is small, when compared 
with loss of a limb, to which few refuse to submit as a mean of prolonging 
life.' "—Med. Chir. Rev. Jan. 1829. from the Glasgow Medical Journal, No. IV. 

63. Treatment of Strictures of the Urethra. — The mode of curing strictures of 
the urethra by confining a large bougie at the anterior part of the obstruction, 
is still employed with undeviating success in the wards of M. Dupuytren and 
of M. Breschet at the Hotel Dieu. The mere contact, accurately preserved for 
eight or ten days, often enables a catheter of the largest size to pass freely 
where the smallest bougie could not previously penetrate. 

" The bougies thus introduced are provided with four very narrow tapes or 
strings, whereby they are attached to a T-bandage, surrounding the waist and 
under the scrotum. In their, passage they are coiled, at equidistant points, round 
a ring which is placed over the body of the penis." — Lond. Med. and Phys. Journ. 
Jan. 1829. 

64. Fatal error in the diagnosis of a tumour. — A peasant boy received a blow on 
the left temple; a tumour was developed which was supposed to be encysted, 
and extirpated. The excision was immediately followed by profuse haemor- 
rhage, which was arrested by compression; and Dr. Krimer sent for, who 
found the patient in convulsions, which soon terminated in death. The extir- 
pated tumour was an aneurismal sac communicating with the middle meningean 
artery, by an opening situated between the squamous border of the temporal 
and the corresponding" portion of the parietal bone. The middle meningean 
artery was of the size of a finger fifteen lines lower than the opening. A de- 
pression in the brain under the aneurismal dilatation existed, which contained 
one and a half ounces of bright blood. — Journ. fur Chirurg. und Augen-heil- 
kunde, Vol, X. 

65. On the removal of loose substances from the knee joint. By Charles Averiei, 
Esq.. — "When it is ascertained that one or more of these substances are lying- 
loose in the cavity of the knee-joint, we have the choice of two modes of prac- 
tice, which may be called the palliative and the curative. The former is the 
method proposed by the late Mr. Hey, of wearing a bandage, or laced knee- 
cap, so as to confine the substances in one spot, and, thereby, prevent its giv- 



238 QUARTERLY PERISCOPE. 

ing pain, by getting between the extremities of the bones forming the joint. 
This practice, I should imagine, is not applicable to those cases in which 
there are two or more substances present; especially if they differ considerably 
in size, and if the patient's occupation subject him to hard labour or severe 
exertion. In such cases, relief may be afforded by the operation of removing 
the substances; but this, from its necessarily laying open the joint, as well as 
from its having been, in some instances, unsuccessfully attempted, has always 
been considered a serious undertaking. 

" The only difficulty that, as far as I am informed, has been found in accom- 
plishing the operation, even when there are two or more substances present, 
is to fix them, whilst the operator cuts into the joint, so that he may extract 
them readily, after the incision is made. This difficulty, which is owing to the po- 
lished surfaces of the loose bodies, and the lubricating nature of the synovia 
favouring their slippery passage from one part of the joint to another, obliged 
the surgeon to relinquish the operation, even after he had cut into the joint, 
in a case of this kind, which was lately related to me by Mr. Thomas Christie, 
an apprentice of Doctor Ballingall, Surgeon to the Royal Infirmary, in Edin- 
burgh. In this case, the operation had been twice attempted, by different 
surgeons, without success; and the patient afterwards went into the Edinburgh 
Infirmary; where the substance was removed by Mr. Allan. 

"Aware of the above facts, I was induced to consider how I might obviate 
the difficulties I have stated, and have been gratified to find that I could do so 
by very simple means. When the patient, whose case is here introduced, came 
under my care, I procured an iron ring, represented in the plate, and found, 
upon trial, that the loose substances in his knee-joint were to be easily fixed 
by it, so securely, in one spot, as could leave no doubt in my mind of their 
being easily extracted. The result will best appear in my notes of the case, 
which are as follows. 

" George Fluck, aged 30, by trade a gardener and nurseryman, was admit- 
ted into the Cheltenham Casualty Hospital, August 16, 1825, when he gave the 
following account of himself. 

" He had, for several years, thought there was a degree of weakness in his 
knees, particularly when he was carrying any heavy weight. Between two and 
three months since, after he had been kneeling for some time in the garden, at 
work, he was attacked with considerable inflammation and swelling in the left 
knee, for which he used an embrocation, and when the swelling went down, 
he found there was a moveable substance in the joint. Shortly after, he dis- 
covered a second. These, at times, caused excruciating pain, more particu- 
larly when he was walking down hill, or coming down stairs, so as to oblige 
him to sit down till the pain had subsided. 

"■ He had worn a bandage, by means of which he could fix the larger sub- 
stance at the upper and outer part of the joint; but the smaller one could not 
be retained in any one place, and it was this, which, from its motion, and from 
its getting between the ends of the bones, gave him pain. 

" At the time of his admission, both substances could be readily felt, and 
moved to different parts of the joint; one appeared to be about the size of a 
marble, flattened; the other considerably smaller. 

" He was recommended to submit to the operation of having them removed, 
to which he consented; and was therefore directed, by way of preparation, to 
take some pills of calomel and extract of colocynth, and some aperient medi- 
cine by day, for two or three clays, and to eat no meat. 

" On the 19th, the operation was performed in the following manner. 

" Both the substances being pushed to the upper and outer side of the joint, 
and the integuments drawn tightly over them towards one side,* while the knee 
was kept straightened; the substances were fixed by means of the ring, which 

* " This was done to prevent the wound in the integuments being- parallel to that in the capsular 
Jigament." 



Surgery. 239 

I held with my left hand, firmly pressed against the side of the outer condyle 
of the femur, thus rendering- their escape back into the joint impossible. 

"I then, with a common scalpel, made an incision, within the ring, through 
the integuments and capsular ligament, from above, downwards into the joint; 
when the larger substance immediately fell out on the floor, and, with my fin- 
ger, I tilted out the smaller one. 

•' The operation was performed in less than a minute, and only about a 
drachm of synovia escaped. There was no bleeding of consequence; the lips 
of the wound were brought together by adhesive plaster, a bandage applied, 
and a long splint was fixed on the outside of the limb, to prevent the knee 
being bent. He was directed to keep quiet in bed, and to take a saline draught 
every three hours. 

" August 20. — He has had a good night, and is free from pain. 

" 22. — The wound dressed, looking very healthy. 

" 28. — Sat up for an hour or two. 

«' Sept. 3. — Discharged quite well. 

"In conclusion, I may be allowed to ask, whether the evils so much dreaded 
in the operation of removing loose cartilages from the joints, may not, in all 
probability, have arisen from the excessive escape of synovia, and the irritation 
produced by unsuccessful attempts to squeeze out those substances at a wound 
made comparatively upon speculation; and whether, if they can be always cer- 
tainly and securely fixed, by the simple means I have employed, the operation 
be not thereby rendered sufficiently safe to authorize us to recommend it with 
confidence; at all events, where the bandage and knee-cap have failed to afford 
relief." — Midland Reporter, No. I. 

66. Lithotrity. — "Mr. Zanabi Pecchioli, an eminent young surgeon, charged 
by the Grand Duke of Tuscany to observe the actual state of surgery in various 
countries, has made a great improvement on, or rather he has added a new and 
important principle to, the lithontriptic instruments invented by Messrs. Leroy 
d'Etoile, Civiale, Amusat, Hourteloupe, &c. &c. We have had a recent op- 
portunity of examining Mr. Pecchioli's instrument, and seeing him work it on 
different calculi — not, of course, in the living body. We would say that its 
superiority over the instruments of the gentlemen above-named, is threefold. 
In the first place, it combines the principles of each of the others, the drills 
and other parts of their machinery being rendered completely available to Mr. 
P.'s apparatus. In the second place, the spring, or ressort, by which the drill 
or perforator is made to bear on the calculus, and which cannot, in the other 
instruments, be made to vary in force, is superseded by the construction of the 
pulley, which enables the operator to modify, vary, augment, or diminish, at 
pleasure, the force used — and that by his own hand. This we conceive to be 
a very important improvement. But the third modification is the most impor- 
tant of all. The perforator or drill, in Mr. P.'s lithontripteur, can, at any period 
of the operation, be converted into a kind of trephine, varying in the diameter 
of its circular movements from the smallest circle up to one of eighteen lines 
in diameter, at the operator's will — and thus becoming capable of grinding 
down the calculus by a series of gyrations equal in extent to the grasp of the 
pincers or tenacula, instead of boring holes, and shifting the instrument for 
each perforation. By this operation, a considerable portion of stone may be 
ground down by a single sitting; and the danger of large and irregular frag- 
ments being scattered about in the bladder, when the calculus is broken after 
many perforations, according to the methods of Leroy d'Etoile and Civiale is 
avoided. 

'• Sir Astley Cooper, Mr. Travers, Mr. Key, and many other distinguished sur- 
geons, have compared Mr. Pecchioli's apparatus with that of M. Civiale's; and, 
without vouching for the general success of the lithontriptic process, they have 
no hesitation in acknowledging the great ingenuity of Mr. P.'s instruments. 
11 P. S. When Sir Astley Cooper was in Paris last month, he went to see M< 



240 QUARTERLY PERISCOPE. 

Civiale operate with the lithontripteur. The subject was not one of the best 
for any operation. M. Civiale threw in half a pint of tepid water — introduced 
the lithontriptor with the greatest ease, seized the stone, drilled it, and then 
crushed it, all in the space of about seven or eight minutes. The operation 
over, the man discharged the water which had been injected, quite turbid with 
the sawings of the stone, and when poured off, disclosing numerous fragments 
that had come away with the first evacuation of the bladder after the opera- 
tion. Sir Astley was quite astonished at the facility with which the whole was 
performed by M. Civiale. We apprehend that this operation must become 
popular in the hands of a few expert surgeons; but we do not suppose it will 
ever become general among surgeons at large." — Med. CMrurg. Rev. Jan. 1829. 

67. Hydrocele. — Professor Graefe cures the congenital hydrocele, and that 
occurring in children a year old, by the application of the aqueous solution of 
hydrochlorate of ammonia with vinegar of squills. Rap. de I'Inst. de Clin. 
Chirur. et Ophth. de VUniv. de Berlin, 1827. 

68. White Swelling successfully treated by Frictions of Iodine. By Dr. Lxjgoi. 
— The use of iodine in scrofulous tumours is strongly recommended by the 
most eminent French surgeons. M. Bresceet, in his lectures, speaks of it in 
the highest terms. The same treatment is pursued with advantage at the H6- 
pital St. Louis, from the records of which a recent cure of white swelling and 
tumour of the jaw may be cited as a proof of its efficacy. 

The patient had white swelling, with several fistulous ulcers, on the knee: 
the leg was bent on the thigh, and utterly useless. He had also a large tuber- 
cular tumour on the right side of the face, which seems to have its origin over 
the maxillary joint. The swelling was such that the man could scarcely open 
his mouth, and the flat edge of a penny-piece was the largest substance he 
could introduce between his teeth. These tumours have entirely disappeared 
under the use of iodine frictions. — Journ. de Hdpitaux. 

69. Aneurism of the Carotid cured by the Method of Valsalva. — In Vol. II. p. 
451, we noticed a case of aneurism of the crural artery cured by M. Larrey by 
the method of Valsalva, conjointly with the application of ice to the tumour; a 
case of carotid aneurism is related in Hecker's Annals, for May 1828, which was 
cured by similar treatment. In the latter case, the aneurism was situated on 
the left side of the neck, and extended from the thyroid body to the clavicle. 
The tumour was soft and larger than a pullet's egg; there was a strong pulsation 
in it, and the colour of the skin covering it was natural. It was cured by the 
continued use from the autumn of 1820 to the spring- of 1822, of a rigid diet, 
consisting of weak soups, bread, vegetables, and of acidulated drinks; aided by 
rest, repeated bleedings, the use of digitalis, of laurel water, and the applica- 
tion of pounded ice. The patient could not support compression of the tu- 
mour; he suffered from time to time angina and difficulty of swallowing. For 
more than two years the patient has enjoyed perfect health. 

70. Case of Aneurismal Condition of the Posterior Auricular and Temporal Ar- 
teries, successfully treated by an Operation. By James Syme, Esq. — Mrs. T. aged 
fifty, applied to Mr. S. on account of a tumour about the size of a large goose- 
berry, which was situated behind the right ear, over the mastoid process. It 
had been first noticed about ten years ago, and had very gradually increased 
until of late, when its progress was more rapid. Pressure had been recom- 
mended by different surgeons, and tried without relief. This tumour, when 
seen by Mr. S. yielded readily to the fingers, and in its place could then be felt 
a considerable depression; so soon, however, as the pressure was removed, it 
immediately filled again, and if the finger was gently applied while this took 
place, a jet of blood could be felt issuing from the bottom of the tumour, and 
the patient heard such a whizzing noise, that she could hardly be persuaded 



Surgery. 241 

the bystanders also did not perceive it. Below the tumour, the posterior auri- 
cular artery could be felt greatly enlarged, and throbbing with violence,- when 
this vessel was compressed, the tumour became flaccid. The patient complain- 
ed of pain and noise in the swelling, the latter being often so distracting as to 
deprive her of sleep. Conceiving it to be an aneurism of the posterior auris, 
Mr. S. with the assistance of Dr. Ballingall, proposed to tie the vessel; but on 
shaving the hair from the side of the head, it was found that the tumour was 
not so circumscribed as it appeared to be, but that not only all the branches of 
the posterior auris were dilated, but also the posterior and middle branches of 
the temporal, all of which were throbbing obviously, though not very forcibly. 

It was now thought that it would be necessary to tie the carotid, but before 
doing so, it was discovered that when the posterior auris was compressed, the 
dilatation disappeared; it was therefore determined to tie the latter vessel as 
originally proposed. It was accordingly exposed a little below where it enter- 
ed the tumour, which was not very easy as its course was perpendicular to the 
surface, and it was included in a single silk ligature. When the ligature was 
drawn, the tumour became flaccid, and the dilated vessels disappeared. The 
edges of the wound were kept together with two stitches. Every thing went 
on well for a week, excepting a slight attack of erysipelas. 

On the eighth day after the operation, while Mr. S. happened to press on the tu- 
mour, a slender stream of arterial blood trickled away from the side of the liga- 
ture. As it soon ceased he merely applied a compress over the wound. The 
haemorrhage recurred twice or thrice in the twenty -four hours on the following 
days, but as it never exceeded an ounce or two he concluded that it came from 
the vessel above the ligature, and therefore contented himself with using super- 
ficial pressure, not in the expectation of arresting the discharge of blood,* but 
in the fear of disturbing, by more efficient measures, the process of obliteration 
going on below the ligature, which would have been attended with more se- 
rious consequences. 

On the twelfth day, conceiving that the ligature must have done its duty, Mr. 
S. examined the wound, and found in the seat of the ligature a small pulsating 
bag, from a crevice in the centre of which the blood escaped. Having detach- 
ed with his nail this little false aneurism, and along with it the ligature which 
was inclosed, he ascertained that the haemorrhage did proceed from the orifice 
of the vessel next the tumour. He then applied some small pieces of amadou 
supported by a graduated compress. 

Every thing went on well afterwards. The wound was dressed at the end of 
three days, when it was suppurating most satisfactorily, and in the course of a 
short time it cicatrized. c ? 

For some weeks after the operation the tumour remained small and flaccid, 
but when the patient resumed her ordinary diet and exercise, it began to re- 
sume its former condition. It was moderately tense; and though no throbbing 
in it could be felt by the finger, Mrs. T. complained of the noise and pain which 
had distressed her previously, in a degree comparatively slight, but sufficient 
to disturb her repose. No appearance of the varicose dilatation of the artery 
could be perceived. 

Finding that the uneasy symptoms continued to increase, and being anxious 
to take advantage of the command which had been obtained for the present 
over the disease by obstructing the principal supply of blood, Mr. S. determined 
to take an effectual step for the patient's relief. 

" On the 29th of October, assisted by Professor Ballingall,I cut directly through 
the long direction of the tumour, which then showed itself to be composed of 
large irregular cells, invested by a firm capsule. While Dr. B. compressed 

* " It is highly important for surgeons to recollect that pressure is of little avail in the stopping of 
haemorrhage unless it is applied directly to the bleeding vessel. If this truth were kept in mind we 
should not so often hear of the humeral artery being tied, since I will venture to affirm, that there is 
no bleeding from injury of the hand, and I will add of the foot, which cannot be commanded by local 
pressure. But the pressure must be applied to the bottom of the wound, and if the orifice is not wide 
enough to admit of this it ought to be dilated." 

No. VII.— May, 1829. 31 



242 QUARTERLY PERISCOPE. 

above and below the tumour, I dissected it out, and then attempted to tie the 
vessels, but finding this very difficult, I adopted the suggestion of Dr. B. and 
included them in ligatures by means of a small curved needle. The ligature 
being drawn, the haemorrhage ceased. I then filled the wound with dry caddis, 
and applied a firm bandage about the head. The patient did not experience 
the smallest inconvenience from this operation, excepting the pain immediately 
attending it. The ligatures separated in about a fortnight, and the wound is 
now completely healed." 

Three other cases of a similar disease are related, one by Pelletan, Clinique 
Chirurgicale, Tom. II. 5 another by Wardrop, and a third by Dr. Maclachlan, 
Glasgow Medical Journal, No. 2. In all these cases the operation was unsuc- 
cessful. — Ed. Med. and Surg. Journ. Jan. 1829. 

71. Hernia, Strangulated at the Superior Internal Orifice of the Inguinal Canal. 
— Dr. Ouvrard relates in his Meditations sur la Chirurgie Pratique, three cases 
of this description, in which he operated with success, a fourth in which the 
operation was unsuccessful, and he also gives an account of the post mortem 
examination at which he assisted, of a fifth patient, who died three days af- 
ter being operated upon. Dissection showed that the aponeurosis of the exter- 
nal oblique had been freely divided, but there was a stricture towards the su- 
perior extremity of the inguinal canal, which had not been divided, and which 
prevented the return of the intestine into the abdomen; the fold of intes- 
tine had been pushed between the peritoneum and abdominal muscles. The 
peritoneum was separated for about two inches, and formed a sac in which the 
intestine was lodged, and to which it had attracted adhesions. 

72. Treatment of Fractures of the Inferior Extremities by Continued Extension. 
— M. Josse, surgeon in chief of the Hotel-Dieu of Amiens, in a memoir publish- 
ed in the Repertoire d'JInatomie, Vol V. after presenting some general obser- 
vations on fractures of the limbs, and the evils which result from the means hi- 
therto employed in reducing them, proposes a new method, which consists in 
placing, with the greatest care, the fractured member in its natural direction, 
without attempting by any force to place the fragments in apposition; for he 
says that there is a great difference between supporting a part, and pulling at 
it. In the first case, nature permits herself to be conducted, in the second she 
revolts; and as long as a struggle is made between the parts of a fractured mem- 
ber and the apparatus with which it is treated, the latter will be overcome and 
the limb shortened. He is contented then to support the parts and prevent 
their beinghdisplaced, by an eighteen-tailed bandage; he next subjects the limb 
to continued extension, and by proper attention, in two or three days, even in 
the severest cases, he always obtains a reduction and perfect coaptation of the 
fractured extremities. This continued extension is kept up by an apparatus 
which M. Josse has invented, but which is rather complex, and we shall not 
therefore describe it: the object may be accomplished in various ways, which 
will readily suggest themselves. 

73. Extirpation of a Wen. — M. Lisfranc has recently extirpated a very 
large wen from a negress, situated above the clavicle, and having prolongations 
under this bone. The external jugular vein, which passed through the whole 
vertical diameter of the tumour, was dissected and preserved; the subclavian 
artery and vein were laid bare; the pleura was visible at the bottom of the 
wound. The patient recovered without any unfavourable occurrence. — Journal 
Generate de Mtdecine, Jan. 1829. 

74. Reduction of a Luxation of five months standing. — M. Lisfraitc has suc- 
ceeded in reducing a luxation of the head of the humerus forwards, of five 
months standing. To avoid the accidents that have lately occurred from at- 
tempts at reducing old luxations, M. L. commenced by making at first slight 
extension, and gradually increased it. — Ibid. 



Surgery. 243 

75. Aneurism by Anastomosis, successfully treated by tying the Carotid. — Dr. 
Abendt, of St. Petersburg-, has successfully treated a case of aneurism by anas- 
tomosis on the right side of the head, by applying- a ligature to the right caro- 
tid artery. 

76. Aneurism of the Bight Primitive Carotid, successfully treated. — There is an 
account in the Annali Universali di Med. for September, 1828, of a case of aneu- 
rism of the right primitive carotid, successfully treated by Dr. A. Molina, of 
Pavia, by means of the ligature. The operation was performed in the manner 
recommended by Professor Scarpa. 

77. Amputation without applying Ligatures to the Vessels. — In Vol. I. p. 462, 
we gave an account of the method of amputating by Dr. Koch, of Munich, who 
has " not tied a single artery in the various amputations which he has perform- 
ed for the last twenty years." 

Professor Graefe relates in his Rapp. Annuel de VInstitut. Ophthalm. Med. 
Chirurg. de Berlin, that during a late visit to Munich, Dr. Koch permitted his 
son, in order to dissipate Dr. Graefe's doubts, to amputate a thigh. It was found 
necessary, however, to apply a ligature to the crural artery. The method of 
Dr. Koch, will not, of course, answer in all cases. 

78. Needle in the Larynx, removed by Laryngotomy. By M. Blandin. — A 
man, aged twenty-five, whilst irritating his nostril with a needle, carelessly let 
go his hold, when the needle passed into the nostril and thence into the pharynx. 
The needle was armed with a large thread, which entered with it, and the 
whole disappeared. Mueh irritation and cough being excited, the thread was 
thrown out of the mouth, and the patient then endeavoured, but in vain, to ex- 
tract the needle by pulling at the thread: every attempt caused acute pain. The 
respiration and voice becoming affected, and all efforts at extraction being vain, 
the patient entered the Hopital Beaujon, June 18th, 1828. At this period the 
pains had considerably increased, the slightest efforts at deglutition augmented 
all the symptoms, so that all movement of the pharynx was impossible; the voice 
was nearly lost; he had a very unusual and remarkable hoarseness, a frequent 
cough, and every effort at coughing produced spasms of the muscles of the neck. 
The soft parts covering the larynx were.much tumefied, the skin red and pain- 
ful. The house pupil, having in vain endeavoured to extract the needle by 
means of the thread, sent for the surgeon, M. Blandin. When M. Blandin ar- 
rived, he found the patient still in the state already described, and in an effort at 
deglutition the thread had entered the pharynx. Not being able to seize the 
thread, and thus to ascertain positively whether the needle was in the pharynx 
or larynx, and the pain of respiration being still supportable, it was determined 
to trust the case to antiphlogistics, general and local, which were employed 
with some success. But on the evening of the 21st the thread was again eject- 
ed, by means of which Dr. Blandin ascertained that the needle had entered the 
superior aperture of the larynx on the left of the epiglottis. On the 22d, the 
symptoms became much aggravated, and it was determined to perform laryngo- 
tomy. This was executed by making a cautious dissection through the indu- 
rated and swollen parts, in front of the larynx, then carefully puncturing the 
crico-thyroid membrane, and afterwards dividing, by means of a director and 
bistoury, the thyroid cartilage, through its whole length, on the median line. 
The respiration was now much relieved, and an attempt was made to discover 
and remove the needle by means of forceps; but they produced so great an ir- 
ritation as to induce the operator to desist. The wound was lightly dressed by 
means of a perforated compress covered with simple cerate, and the patient 
put to bed. The night was passed comfortably, and the next day the needle 
was found fixed in the compress covering the wound. The wound gradually 
healed, so that by the beginning of September only a small fistula remained, 
but the voice was hoarse. There was some pain in the larynx, and other indi- 



244 QUARTERLY PERISCOPE. 

cations of chronic inflammation, for which leeches, a seton to the back of the 
neck, &c. were prescribed, and afterwards mercurial frictions on the sides of 
the larynx? and caustic to the fistula. On the 30th of September the fistula 
was closed, and the voice had acquired more force. — Journal Hebdomadaire de 
Mtdecine, No. I. 



MIDWIFERY. 

79. Injection of vinegar and water into the umbilical vein in cases of Uterine 
Haemorrhage, depending upon Retention of the Placenta. — The evidence in favour 
of this new remedial measure, which we have already made our readers acquaint- 
ed with, is increasing. Dr. Jemina, relates in the Repertorio di Med. di Torino, 
for August, 1828, three cases of uterine haemorrhage depending on partial at- 
tachment of the placenta, in which he succeeded in effecting its detachment 
by injecting the umbilical vein with cold water, in which a little vinegar was 
mixed. 

Dr. F. O. Doucet, of New York, also relates a successful case in the New 
York Medical and Physical Journal for December, 1828. 

80. Mr. Mantel's Report of Midwifery. — In the midwifery practice of a healthy 
country town, the number of Cases being 2510; there were 4 arm presentations, 
or 1 in 600; 8 in which turning was required, or 1 in 300; 6 in which the for- 
ceps were employed, or 1 in 400; 3 cases of embryotomy, or 1 in 800; 6 cases 
of puerperal convulsions, or 1 in 400; 2 cases were fatal. — Lond. Med. Gaz. 

81. Case of Difficult Labour in consequence of the Enlarged State of the Kid- 
neys of the Foetus. — In the first number of Gemeinsame deutsche Zeitschrift fur 
Geburtskunde, a case of this kind is related by Professor Osiander of Gottin- 
gen. The kidneys were as large as in the adult, and greatly distended the ab- 
domen. The other viscera of this cavity were very small. 

82. Absorption by the Uterus. — Dr. F. C. Naegele, Professor of Midwifery in 
the University of Heidelberg has published in Froriep's Notizen some cases 
which seem to show that the placenta when retained after the delivery of the 
child is sometimes absorbed by the uterus. In 1802, Dr. N. was called to a 
lady, who in consequence probably of fatigue, "was brought to bed between 
the twenty-fourth and twenty-sixth week of her pregnancy; the child lived se- 
veral hours after birth; little haemorrhage followed, but the placenta did not 
come away. The cord, which was very thin, had been torn off at its insertion, 
as far as could be judged from the length of it. The midwife, who was an ex- 
perienced as well as a highly respectable person, informed me that it had oc- 
curred as she passed her finger along the cord to ascertain whether the after- 
birth were already separated; and assured me that she had not exerted too 
much force in endeavouring to extract it, in which account the bystanders also 
agreed. The lady and her friends were under considerable alarm on account 
of the placenta not coming away; and the midwife, who suffered not less anx- 
iety for her patient, scarcely quitted the bedside for the first nine days, and 
even passed the night in her room; so that the case was watched with the 
greatest attention. The lochia, which was sparing and devoid of fetor, and 
with scarcely any coagula of blood, lasted only four days. A slight attack of 
fever was experienced twenty -four hours after delivery, unattended, however, 
with any pain of the abdomen. The breasts did not swell, the menstruation 
returned in eleven weeks, and in about three years after she bore a child at the 
full period of pregnancy. 

"In another case, in 1811, where abortion had occurred between the four- 
teenth and fifteenth week, from no assignable cause, and with scarcely any hae- 



Midwifery. 245 

morrhage, and which I had an opportunity of observing with the greatest accu- 
racy, the secundines did not come away; a febrile attack came on upon the 
third day, which soon disappeared? no local pain, no discharge from the parts 
of generation; the menses returned after nine weeks, and no traces of the pla- 
centa, &c. ever appeared. 

"An experienced accoucheur of this place, (Dr. Gotzenberger,) has had the 
opportunity of attentively observing two cases of this kind, and assured me po- 
sitively that he was perfectly convinced that no trace of the placenta had been 
detected, either in a solid or in a partly dissolved state." 

This circumstance having interested Dr. N. considerably, he has, he says, 
endeavoured of late years to excite the attention of several of his professional 
friends, and at various times has received from them accounts confirming the 
truth of his observations, "both in cases of premature labour, where the pla- 
centa had been retained, as also of labour at the full term of pregnancy, where 
large portions of it had remained attached, where no traces of it in either in a 
solid or half-dissolved form had come away, and this had occurred without any 
injurious consequences." 

Professor Sebastian, of Heidelberg, having lately returned from a journey to 
Holland, has communicated to Dr. N. a most interesting case which he receiv- 
ed from the mouth of Dr. G. Salmon, of Leyden, where, after labour at the 
full period of pregnancy, the whole placenta had been absorbed, and the case 
terminated successfully. 

I am far from denying, says Dr. N. the liability to deception in cases of this 
sort, and am well aware how extremely difficult it is to form a correct opinion 
upon them. A comparison of this with processes of a similar nature, more espe- 
cially with those that are observed to take place in cases of extra-uterine preg- 
nancy, and also in animals, and a more elaborate discussion of the subject in a 
practical point of view, which has engaged my attention for some time, has 
made me very anxious to avail myself of the experience of others who may en- 
joy more extensive means for observation than myself. 

83. Table of Labours in the Clinic of Heidelberg, from the 1st of January, 1825, 
to the Slst of December, 1826. By Professor Naegele. — In this interval of two 
years there were 412 deliveries, of which 6 were twin cases, and 3 abortions. 
Omitting these last, there were born 415 children, of whom 199 were boys, 
and 216 girls; of these 415, 398 were head, 15 breech or feet, 1 arm, and 1 
shoulder presentations. 

Of the head presentations, — 394 presented the cranium, (of which 378 were 
natural,) and 4 the face. In 16 cases the position was not accurately determin- 
ed. The cranium presented, in 253 cases, the right parietal, (as the part most 
advanced,) the posterior fontanelle being turned more or less to the left and an- 
terior part of the pelvis; and in 125 cases, the left parietal, the posterior fon- 
tanelle being in a direction opposed to the former. The ordinary turns of the 
head occurred in all these cases, except one, in which the left frontal appeared 
at the outlet of the pelvis, and the face was turned up behind the pubis. The 
child being small, delivery was prompt. In the four face presentations, the 
forehead was on the left side in 2 cases, and on the right in the remaining 2. 

Of the 418 births, 319 were finished by the natural powers, and 19 with arti- 
ficial assistance, viz. 15 by the application of the forceps, 3 by turning, and 1 
by perforating the cranium. 

Of the 412 mothers, 410 left the clinic in good health; two died: 387 chil- 
dren were born alive, and 31 dead; of these last, 16 were dead before the com- 
mencement of labour. There were 19 premature labours, including the three 
abortions. The labours with the face presenting were fortunate. The children 
lived with one exception, owing to a prolapsus of the cord. The breech cases 
gave 11 living children, 1 was born with some signs of life, and 3 were dead; 
2 of whom manifested signs of putrefaction, and the third was premature. In 
the forceps cases, all the mothers and 13 children survived; 2 children were lost 



246 QUARTERLY PERISCOPE. 

by the prolapsus of the cord. Turning- was indiculed in 2 cases by oblique or 
transverse positions of the foetus, with presentation of the shoulder or arm; the 
infants were dead. In the third case turning was required for a prolapsus of the 
cord; the infant was born in a state of asphyxia but was soon recovered. Perfo- 
ration of the head was made where the anteroposterior diameter of the pelvis 
was only 3 inches. Labour had lasted several days. Rupture of the uterus 
occurred, the infant, which was dead, was drawn down by the feet without 
difficulty until the head presented, which was then opened, and the child was 
extracted. The mother died from abdominal inflammation. 

Premature labour was excited in one case of narrow pelvis. The infant was 
born alive, and the mother did well. There were 4 cases of uterine haemor- 
rhage; 3 before the exclusion of the placenta, and one 24 hours after. They 
were successfully treated by the tincture of cinnamon given internally, and by 
cold affusions on the abdomen. In one case, the placenta was artificially se- 
parated.— Revue Medicale, Dec. 1828. 

84. Case of Retroversion of the Womb. By J. P. Ouvrard. — Madame Cady, 
of Longuennee, near Chalonnes, aged fifty-four years, sent for Dr. O. on the 
24th of July, 1812. She had been suffering for twenty -four hours, during which 
time she had passed neither urine nor feces. The bladder was enormously dis- 
tended with urine. The most pressing inclinations led to incessant efforts either 
to urinate or go to stool; she complained at the same time of violent colic, with 
severe pains in the loins and thighs; her body was covered with a cold sweat, 
and her pulse was small and intermittent. After having ascertained the reten- 
tion of urine, Dr. O. hastened to introduce the catheter, which, however, he 
was not able to do without some difficulty. Nevertheless, the bladder emptied 
itself completely, when all the alarming symptoms suddenly dispersed, except 
those about the rectum, which still prevented the patient from going to stool. 
Suspecting from this circumstance that the cause of this double accident was 
situated in the vagina, he examined this organ, and found the mucous mem- 
brane, which lines it posteriorly, forming at its orifice a thick cushion. The 
fundus of the uterus was situated below, and on the right, supported upon the 
hollow of the sacrum; its neck lay under the arch of the pubis, where it pressed 
strongly upon the urethra, whilst the summit of the fundus compressed the rec- 
tum against the sacro-iliac symphysis. Thus the neck was higher than the fun- 
dus; and, whilst from its situation in the axis of the perineal strait, the posterior 
face of the uterus became the inferior, the anterior became the superior. By 
introducing two fingers into the vagina, Dr. O. was enabled to push the fundus 
of the uterus upwards, and at the same time bring down the neck of that organ, 
which resumed its natural position. After having mentioned the age of the pa- 
tient, it would be superfluous to add, that the uterus was empty, and contained 
no foreign body. Madame Cady informed Dr. O. that the affection manifested 
itself suddenly, in consequence of efforts made by her to lift a weight. — Medi- 
tations sur la Chirurgie Pratique. 

85. Case of Premature Birth, attended with some uncommon Circumstances. 
By J. J. Cribb, Esq. Surgeon. — " Mrs. R. aged about 40, was taken with labour 
November 2d, 1827. She had been married fifteen or sixteen years, and has 
several living children, born in the course of a few years immediately succeed- 
ing her marriage. Her three or four pregnancies preceding the present had 
terminated in abortion, about the middle of the period of gestation. In the 
present instance she told me that she menstruated last on Easter Sunday, which 
was on the 15th of April; consequently, even if she had become pregnant im- 
mediately after that period, she could not be advanced more than twenty-eight 
or twenty-nine weeks. The labour proceeded, and in a short time the ovum 
was expelled entire, the membranes, not having been ruptured, still enclosing 
the fetus floating in the liquor amnii. On breaking them, the child was found 
alive, and it appeared perfectly formed, but from its diminutive size and prema- 



Medical Jurisprudence. 247 

tare birth, its life, it was expected, would soon terminate, as is usual in similar 
cases. To the surprise of every one, however, it continued to live, was able to 
swallow some gruel which was given it, and, a day or two after, to suck the 
breast of the mother, although its cry, or rather whine, was so feeble as scarcely 
to be heard the length of the room. As there was some probability of its life 
being preserved, I proposed to the parents, as a matter of curiosity, to ascer- 
tain its weight, but to this they at that time objected. The child is still living, 
and at the beginning of the present month, the parents informed me that, when 
it was six weeks old, they ascertained its weight to be, (deducting the weight 
of the clothes,) two pounds two ounces,- that since that time they have regularly 
weighed it once a week, and found it increase in various degrees; at present, 
being ten months old, its weight is twelve pounds. Although * very weakly,' 
its health has not been bad, and it is now able to stand for a short time when 
set against the seat of a chair, without any other support/' — Lond. Med. and 
Surg. Journ. Nov. 1828. 



MEDICAL JURISPRUDENCE. 

86. Case of Premature Birth of a Living Child, without the Introduction of Air 
into the Lungs. By Dr. J. P. Oxjvkabd. — On the 14th of May, 1825, Dr. 
Ouvrard, of Angers, examined a male infant, born the preceding day, after an 
ordinary labour, in the wards of the Maternite. The child had lived fourteen 
hours, of which fact there could be no doubt, since it happened in the midst of 
the patients and students of midwifery. The subject measured fifteen inches 
nine lines in length, eight inches nine lines from the top of the head to the um- 
bilicus, and seven inches from the umbilicus to the sole of the foot. It was well 
formed and weighed four pounds and a half; the hair and nails were developed, 
notwithstanding which it is probable that this child had not attained more than 
eight months from conception. 

On the occipital region there was a lump, and extravasation of blood in the 
cellular tissue. The dura mater corresponding to the posterior fontanelle, was 
ecchymosed and dark coloured. The pia mater exhibited a net-work of vessels 
filled with black blood; the cerebral pulp was white, and not spotted with 
blood; it was filled with red lines, but the vessels, when divided, did not dis- 
charge blood. The cerebrum, cerebellum, and annular protuberance, weighed 
eight ounces four drachms, the spinal marrow fifty-four grains, the cerebral 
pulp was soft and fluctuated when touched. 

The lungs were dense, reddish, and heavy. Thrown in a mass upon water, 
they subsided to the bottom; cut into slices they still sunk; the left lobe press- 
ed under water suffered nothing to escape but a red substance, (bouillie,) with- 
out any air bubbles. The right lobe subjected to the same test, allowed some 
bubbles of air to escape, from the midst of a'reddish and frothy fluid. In other 
respects the lungs were without crepitation, and bore a resemblance exteriorly 
to liver broken and divided into fragments. 

The gastro-intestinal mucous membrane was rose-coloured through its whole 
extent, especially in the small intestines; the rest of the viscera appeared sound. 

This fact proves that life may be supported, (though doubtless very imper- 
fectly,) after birth, in an infant which does not breath enough to introduce air 
into the chest, and dilate the lungs. It also proves that the conclusions often 
drawn from the sinking of the lungs are not always strictly true, since in the 
instance I related the child lived fourteen hours, without our being able to say 
that it had breathed, though this might have happened; for otherwise, how can 
we suppose life to have existed. Dr. Ouvrard has seen a child born which lived 
six hours, without being able in any manner to establish that it had ever re- 
spired. It therefore shows, that if the smallest quantity possible of air enter the 
lungs, life may be sustained some hours or less. Nevertheless, this fact by no 



248 QUARTERLY PERISCOPE. 

means overthrows the conclusions which ought to be drawn from pulmonary in- 
spection. Does cutaneous respiration suffice in this case for the momentary' 
support of life? — Meditations sur la Chirurgie Pratique. 

87. Case in which an Infant Cried Previous to its Expulsion from the Organs 
of Generation, with conclusions which may he deduced from it, connected with Me- 
dical Jurisprudence. By J. P. Ouvb.ard. — On the 11th of February, 1825, Dr. 
Ouvrard was called to assist at the accouchement of a lady about twenty-one 
years of age, who had never before had a child, and had experienced labour- 
pains for several hours. The labour advanced regularly during twenty hours. 
At eleven o'clock in the evening, a violent pain freed the head, (which was in 
the first position,) from the vulva. Immediately the occiput, the forehead, the 
eyes, and the nose, rolled over the fourchette, the mouth presented itself at the 
orifice of the vulva, and the chin caught upon the soft parts. In this position 
the infant sent forth a gentle cry; Dr. O. disengaged the chin, and the head was 
liberated. With affairs in this situation, he waited twenty-five minutes for a 
new contraction of the womb to effect the delivery of the shoulders. During 
all this time the infant never ceased giving such sharp, piercing, and loud cries 
as could be heard over the house. These cries, however, ceased all at once; 
the face became violet, and the infant was threatened with apoplexy. Seeing 
the danger, he hastened to disengage the shoulders, and thus put an end to the 
delivery. He drew blood from the umbilical cord, and soon afterwards the re- 
spiration was re-established. The mother soon recovered from her accouche- 
ment, which was followed by nothing unfavourable, and gave birth to a stout 
boy. 

In reading this account, says Dr. O. some will perhaps be astonished at the 
levity with which certain physicians called upon to give their opinions in cases 
of infanticide, pronounce positively that the child has lived because it has 
breathed. This last circumstance, however conclusive it may appear, is never- 
theless no indubitable evidence of life. Dr. O. goes still further, and says, that 
in cases similar to the one just related, it does not even constitute a sign, since 
it must always happen in this species of labour, that without the foreign assist- 
ance of the hand to disengage the shoulders, the infant must infallibly perish. 
Pulmonary examination, and all the observations relative to specific gravity, can 
only establish a single point, which is, that the child has breathed. This posi- 
tion will be found amply confirmed by Dr. Schmidt, who has noticed twenty-six 
cases perfectly analogous to that which I now report, and also by M. Osiander, 
who has had opportunities of collecting eight cases. I am far from wishing to re- 
ject the lights furnished us by pulmonary inspection, nor to overthrow the esta- 
blished principles relative to this subject; but when I consider that the infant 
of which I speak was upon the point of perishing by strangulation, I tremble to 
reflect that if the case has been possible once, similar ones may have happened 
before. Let us for example suppose that the mother had some interest in con- 
cealing her pregnancy, what might have happened? Abandoned and alone in 
an obscure place, without light, or any assistance, the shoulders remaining in 
the situation that I have described, the neck of the uterus strongly embracing 
the neck of the child, this must have died of apoplexy, and perhaps even pre- 
sented on its neck the impression of uterine constriction; the physician called 
upon as a witness, would have discovered that the infant had breathed, but 
that it had died of apoplexy from strangulation. Upon this, a verbal process 
would have been issued, and in conformity to the present state of the science, 
an innocent woman, a perfect stranger to so odious a crime, would have been 
sent to the scaffold. 

It is therefore important that we proceed more deliberately, make our deci- 
sions with more circumspection, and especially avoid forming such positive con- 
clusions; hereafter it will be necessary to take into account the instances in 
which children have been known to cry and breathe previous to birth, under 
pain of confounding a most horrible crime, with the pure accidents of accouche- 



Medical Jurisprudence. 249 

ment. A child is said to have lived, when, expelled from the organs of gene- 
ration it has exhibited for a certain time all the acts of life; thus the infant whilst 
still retained in its mother's womb, may breathe, since it can send forth cries; 
but if it perish whilst still retained in the uterus, although it has breathed, it 
cannot be said to have lived. Respiration does not establish the point of life, 
notwithstanding that life supposes the necessary existence of respiration, since 
without the establishment of that function, extra-uterine life could not take 
place. — Meditations sur la Chirurgie Pratique. 

88. Vagitus Uterenus. — It is believed by many German writers on medical juris- 
prudence, that the foetus may sometimes be heard to cry in the uterus, the fact 
however is questioned. M. Lesaurage, of Caen, has transmitted to the Royal Aca- 
demy of Medicine of Paris, as evidence of the fact, an account of a bitch which 
was taken sick when far advanced in pregnancy, and on approaching her there 
was distinctly heard, even at the distance often paces, the cries of her pups, 
whose movements could also be seen through the abdominal parietes. She did 
not bring forth her young till two days after. — Revue Medicate, Feb. 1828. 

89. Remarkable Symptoms produced by poisoning with Belladonna. — " A gentle- 
man who had been accustomed to take occasionally a purgative mixture con- 
taining forty-six grains of jalap, sent to his apothecary, instead of his physician's 
French recipe, a translation of it by himself into Latin, in which he had used 
the word Belladonna as the proper equivalent for the French name of jalap, 
Belle-de-nuit. The mixture was faithfully prepared according to the formula, 
and taken by the patient about six in the morning. The first effect was most 
violent head-ache, commencing about an hour afterwards, affecting chiefly the 
orbits, and accompanied ere long with excessive redness of the eyes, face, and 
subsequently of the whole body. In a few minutes the entire skin presented a 
uniform redness, exactly like that of scarlatina. The patient was also affected 
at the same time with intense redness of the throat, and great heat, which 
seemed to spread throughout the whole alimentary canal. Another symptom 
no less remarkable was an extremely painful irritation of the whole urinary 
passages, and especially of the neck of the bladder; in consequence of which 
the patient, amidst a continual talkative delirium, that always bore reference to 
the suffering he experienced in that quarter, was constantly demanding the 
chamber-pot, yet each time succeeded in passing with difficulty only a few 
deep-red sanguinolent drops. The physician who was summoned to his assist- 
ance at ten, after discovering the error which had been committed, immediately 
directed a copious blood-letting, emulsive drinks, and emollient fomentations 
of the whole belly. The pain in the region of the bladder nevertheless con- 
tinued without abatement; and the patient, fatigued by his suffering and the 
fruitless efforts he constantly made to pass urine, insisted that the catheter 
should be introduced, although he was assured that his complaint was a sup- 
pression, and not a retention of urine. In fact, during the physician's absence, 
he actually sent for a surgeon and had the operation performed, but of course 
without receiving any benefit; a few drops only of bloody urine were with- 
drawn. Twenty leeches were subsequently applied to the hypogastrium; and 
from this treatment he experienced much relief in the course of a few hours. 
He passed a quiet night, and next morning complained only of a general feel- 
ing of discomfort. M. Jolly, the relater of this case, states that he has repeat- 
edly seen the powder and extract of belladonna cause a similar scarlet efflores- 
cence; and puts the question whether its tendency thus to induce an affection 
of the skin and throat parallel to that caused by scarlatina will not account for 
the property lately ascribed to it, especially by some German physicians, of 
protecting the system from the infection of that disease." — Ed. Med. and Surg. 
Journ. Jan. 1829, from the Nouvelle Bibliotheque Me'dicale JuilleU 1828. 

No. VII.— May, 1829. 32 



250 QUARTERLY PERISCOPE. 

90. Rupture of the Bladder. — Mr. Delvab. relates a very singular and interest- 
ing case of this, in the Edinburgh Medical and Surgical Journal, for January 
last. A man, much addicted to the use of ardent spirits, was engaged, on the 
evening of October 1st, in a drunken brawl, in which he received a number of 
blows, in particular a severe one near to the superior and anterior part of the 
groin, on the left side, and another on the same side but nearer the back, both 
of which knocked him down. " It was proved in evidence, that for about an 
hour after, he assisted in unloading a vessel, without complaining of any in- 
jury; staggered home about midnight, and went to bed; arose early in the 
morning; twice drank more spirits; was seen wandering about in a state of ap- 
parent intoxication ; fell about mid-day on the smooth ground near his own house ; 
could not rise without assistance; was carried home and put to his bed, from 
which he never arose." 

" When carried to his own house, he could not stand, and complained of pain 
in his bowels and faintness. The pain, almost from the first, was accompanied 
with some degree of swelling and tension of the belly, which gradually increas- 
ed until his death. The pain was principally confined to the hypogastric and 
right hypochondriac regions. His mind was confused from the beginning, and 
the torpor increased as the mortal symptoms advanced; but until a very short 
time before his death he could easily be roused, so as to return rational answers 
to any questions which were put to him. On the most accurate investigation, 
it could not be ascertained that he had voided any urine from the time that he re- 
ceived the blows." 

We pass over the treatment as of no consequence, merely mentioning that 
"the catheter was not passed." He died on the evening of the 5th. On ex- 
amination the next day, the following appearances were observed: several marks 
of severe bruises on the thighs and legs; abdomen considerably enlarged; on 
opening the abdomen between nine and ten pounds of a bloody fluid flowed 
out, having no particular smell; there were, besides, about three pounds of 
clotted blood among the bowels, but principally in the pelvis; whole perito- 
naeum of a dirty red colour; when its surface was wiped with a sponge, a layer of 
" colouring matter was rubbed off, and underneath was seen a beautiful arbo- 
rescence of hair-like blood-vessels. In every other respect the viscera were 
sound, except the bladder, which was greatly contracted in its capacity, and 
thickened in its coats, and was ruptured along its superior and anterior surface 
to the extent of three inches and a half. The edges of the wound were rag- 
ged, as if the bladder had been rent asunder by some sudden violence." 

It is a difficult question to decide when this rupture of the bladder took place. 
It is scarcely credible that it happened during the brawl five days before death, 
for the presence of extravasated urine in all the textures of the living body is 
accompanied with such severe symptoms, that we would have expected, had 
the rupture occurred then, that evidence of effusion would have been manifest 
in a shorter period than fifteen or sixteen hours. Mr. D. thinks it "more pro- 
bable that the bladder gave way at the time that he stumbled near his own 
house. The bladder, it may be supposed, was distended to the uttermost, (for 
there is reason to believe that he made no water from the time of the scuffle,) 
and the concussion which the body received in falling had burst asunder its 
coats." This explanation, he admits, has its difficulties; the bladder was so much 
diminished in its capacity that it could not have contained above three ounces of 
fluid, and its muscular coat was increased to at least half an inch in thickness; 
moreover, he merely stumbled and fell forwards on perfectly smooth ground, 
where there were no stones or projecting substances. The laceration cannot 
be attributed to over-distention of the bladder, as in such cases, there is no rent; 
the urine escapes by minute openings, produced by ulceration. 

The fact of the thickening of the bladder is also curious, as the man never 
complained of difficulty in passing urine; he had no stone, nor any stricture in 
the urethra. 



Chemistry. 251 



CHEMISTRY. 

91. New Compound of Silica and Potassa. — " This compound, which has been 
prepared and described by M. Fuchs, is intermediate between glass and the 
oil of flints. It may be prepared by saturating" a boiling- solution of potash with 
recently precipitated silica; but better by the following* process. Fuse a mix- 
ture often parts carbonate of potash, fifteen of quartz, and one of charcoal; 
pulverize the product, and dissolve it in four or five parts of boiling- water, 
which will slowly take up nearly the whole. The solution, evaporated until 
of a specific gravity of 1.24, will be a viscid, opalescent liquid, which, whether 
evaporated further, quickly or spontaneously, will become a solid, vitreous, 
transparent mass, fixed in the air, and resembling- ordinary glass, except that it 
is less hard. 

" This substance has an alkaline action, it dissolves with difficulty in cold 
water, more easily in boiling water. It is somewhat hygrometric, and in many 
weeks will attract moisture from the air, which penetrating it, does not how- 
ever destroy its aggregation, but causes the surface to become covered with 
scales or powder. Alcohol precipitates the aqueous solution; acids decompose 
the substance; many salts form insoluble precipitates with it. This new silicate 
of potash is composed of sixty-two parts silica, twenty -six of potash, and twelve 
of water. It may be employed as a coating for wood and other objects to 
preserve them from fire, and also as a lute in the lab oratory." — Lond. Med. and 
Surg. Journ. Feb. 1829, from Kastner's Archives. 

92. Discovery of the Mode of Making the Diamond. — "At a meeting of the 
Academy of Sciences, on November 3d, M. Gastal stated that he employed 
phosphorus for the purpose of decomposing the carburet of sulphur, by which 
the carbon was set at liberty under the form of small crystals, having all the 
properties of the diamond, and possessing the power of cutting or scratching 
the hardest bodies. If sticks of phosphorus are introduced into a matrass con- 
taining carburet of sulphur, covered with a layer of water, as soon as the phos- 
phorus comes in contact with the carburet, it dissolves as it would in water of 
140° or 158° of Fahrenheit, and is precipitated to the bottom of the vessel. The 
mass then consists of three distinct layers: the upper part of pure water, the 
second of carburet of sulphur, the third of liquified phosphorus. If the liquor 
is agitated while in this state, so as to mix the different substances, it becomes 
milky and turbid, and after remaining some time still, it separates anew, but 
apparently into two layers. The upper is formed by pure water, and the lower 
by phosphuret of sulphur. Between these layers is a very thin one of white 
powder, and which, when the matrass is held towards the rays of the sun, pro- 
duces all the effects of a prism, and consequently seems to be formed by mi- 
nute crystals. 

" The author, encouraged by this experiment, endeavoured to obtain more 
voluminous crystals, which he succeeded in doing by means of the following 
process: — He introduced into a matrass, which was perfectly still, first eight 
ounces of water, then eight ounces both of carburet of sulphur and of phospho- 
rus. As in the preceding experiment, the phosphorus first dissolved, and the 
three liquids took their stations in the vessel according to their specific gravi- 
ties. After twenty-four hours, a very thin pellicle, consisting of a white pow- 
der intermixed with air bubbles and different centres of crystallization, was 
formed. After some days these pellicles gradually increased in thickness. The 
separation of the two lower liquids became less distinct, and after three months 
they seemed but one substance. The experiment having been left in action 
for another month, it became necessary to discover the mode of separating the 
crystallized substance from the phosphuret of sulphur, which was difficult on 
account of the inflammable nature of the substance. After various trials, more 
or less successful, the author determined to filter the whole through cha- 






252 QUARTERLY PERISCOPE. 

mois leather, which he placed under a glass bell, renewing the air from time to 
time. At the end of a month the skin was washed and dried, when M. Ganal 
was enabled to examine the crystallized substance which remained on its sur- 
face. Exposed to the rays of the sun, it presented numerous crystals, reflect- 
ing all the colours of the rainbow: twenty among them were large enough to 
be raised with the point of the knife; three others were as large as a millet seed. 
The latter were submitted to the inspection of M. Champigny, director of the 
jewellery workshops of M. Petelot, and they appeared to him to be real dia- 
monds. M. Gay-Lusac stated that to his knowledge, M. Ganal had been oc- 
cupied in the same research for a period of eight years. 

" Five years since, in the month of January, 1824, M. Delatour deposited 
with the French Academy of Sciences a paper, whose contents were then un- 
known, but have since proved to relate to the manufacture of the diamond, and 
contain, we presume, the results of the first essays of this gentleman. The 
method is still a secret, and said to be essentially different from that of M. Ga- 
nal just described. 

"On the 11th of November, glass tubes were exhibited to the Academy, 
filled with diamond dust, or, (to speak more accurately,) carbon crystallized by 
art. The different specimens were not obtained by the same method. The 
chemical properties are the same, but in appearance and hardness they are 
strikingly different. 

" One of the tubes contains a very transparent small crystal, whose form is 
distinctly pyramidal. M. Delatour expects to present to the academy crystals 
of four or five lines in diameter. 

" M. Arrago remarked on this occasion, that it would be easy to ascertain 
the nature of one of the crystals, as its * facettes' were sufficiently large to 
show the angle of prolongation. He stated also that a person of his acquaint- 
ance entertained a hope that the decomposition of carburet of sulphur by the 
voltaic pile would be successful. The defective conductibility of this substance 
had hitherto impeded the success of the experiment, but it is confidently ex- 
pected that this difficulty will be overcome." — Land. Med. and Phys. Journ. 
Feb. 1829. 

93. Nature of Aloetic JLcid. — M. Liebeg finds this substance to be a combina- 
tion of carbazotic acid and a particular substance having many of the properties 
of resins. The bitter of aloes may be formed in large quantity, by acting upon 
aloes with nitric acid of the specific gravity of 1.25. The substance obtained 
forms a purple salt with potash, but little soluble, and precipitating the salts of 
baryta, lead, and peroxide of iron, of a deep purple colour. When a solution 
of this salt was precipitated by acetate of lead, the water employed to wash the 
precipitate had a yellow colour, and deposited small crystals of the same colour. 
These crystals heated in water with sulphate of potash, gave carbazotate of 
potash, and from that carbazotic acid was obtained. 

When aloes are treated with nitric acid of specific gravity 1.432, until the 
liberation of nitrous vapour ceases, and the liquid be mixed with a little water 
to separate a small quantity of bitter principle, then, by neutralization with pot- 
ash and evaporation, a large quantity of carbazotate of potash in fine crystals is 
obtained. 

Wool, morphia, narcotine and myrrh, did not give carbazotic acid by treat- 
ment with nitric acid. — Annales de Chimie. 

94. Sugar of Liquorice. — " The peculiar principle in the root glycyrrhiza has 
been long known. Doberuner and Robiquet have given processes for its se- 
paration. The following is by M. Berzelius: — The cut root is to be infused in 
boiling water; the cold filtered infusion is to have sulphuric acid added in small 
quantities, until no further precipitate is formed. The precipitate is a com- 
pound of the acid with the saccharine matter, and is to be washed at first with 
acidulated cold water, and then with pure water, until no free acid appears 



Miscellaneous. 353 

The precipitate is to be digested with alcohol, which leaves certain impurities, 
and then pulverized carbonate of potash or soda is to be added to the solution, 
until it is neutral; the clear liquor is to be decanted and evaporated. It is de- 
sirable to have a small excess of acid present, for which purpose put a little of 
the alcoholic liquor on one side, to be added at last to the neutral portion, and 
then leave the whole at rest, that the sulphate of potash may separate before 
the evaporation is effected. 

"The saccharine principle is a transparent yellow mass, breaking like amber. 
Being heated it melts, and burns with a bright flame and much smoke. In 
powder it burns like resin or lycopodium. It does not change in the air. Its 
aqueous solution is precipitated by all the acids, and the more completely the 
stronger is the solution. The precipitates have no acid taste, but are sweet; 
they dissolve in water, and gelatinize upon cooling, if the solutions are strong. 

"This substance also combines readily with bases forming soluble neutral 
solutions; those with baryta and lime are not precipitated by carbonic acid. 
This principle forms insoluble compounds with metallic acids and many me- 
tallic oxides. It combines also with many salts, causing their precipitation in 
some cases. 

" The saccharine principle of the root of the wild liquorice, f Poly podium vul- 
gare,J is altogether different in its qualities from the above substance." — Jour- 
nal of Science. 

95. Iodine Detected in the Blood. — M. Bensterscheidt has detected iodine in 
the crassamentum of the blood of a person who had employed for a long time 
frictions with iodine ointment. He could not find any indication of its presence 
in the serum. 

96. Benzoic Acid in the Grasses. — " Benzoic acid has been found by M. Vogel 
in the sweet-scented vernal grass, ( Antoxanthum odoratum,J and in the sweet- 
scented soft grass, fHolcus odoratus.J It is these two grasses which communi- 
cate to hay the aroma peculiar to themselves." — Lond. Med. and Surg. Journ. 
Nov. 1829. 

97. New Alcali in the Eupatorium Cannabium. — M. Righini has discovered 
a new alcali in the Eupatorium cannabium, to which he has given the name of 
Eupatorine, and which he considers as the active principle of this plant. This sub- 
stance is obtained in the form of a white powder; has a taste sui generis; is in- 
soluble in water; soluble in sulphuric ether and diluted alcohol. It swells in 
the fire and burns. It combines with sulphuric acid, and crystallizes in needles. 
M. R. has obtained Eupatorine in too small quantities to try its medical proper- 
ties. — Repertorio di Medic. Torino, August, 1828. 



MISCELLANEOUS. 

98. Medical Statistics of the Netherlands. — From the researches of the Royal 
Commission of Statistics of the Netherlands, it appears that the excess of male 
children over those of the female sex is 1 to 0.9427; thus in the course of ten 
years there were 30,485 boys born above the number of girls; but the mortality 
among the males is greater than among the females, and in ten years this excess 
was 25,400; so that at the end of ten years the excess of the males was only 
5,085. The deaths throughout the kingdom are 1 in every 39 86-100 persons, 
and the births 1 for every 28 16-100 persons. One of the most curious and in- 
teresting approximations of two natural phenomena, however, connected with 
population, is that stated in M. Quentelet's " Researches on the Population, 
Number of Births, Prisons and Poor-houses, in the Kingdom of the Nether- 
lands." It appears from a series of observations, made for the space of eighteen 



254 QUARTERLY PERISCOPE. 

years, and which he adduces, that the number of deaths, as well as that of births, 
have been in an inverse ratio to the thermometrical variations of the atmosphere. 
Thus the march of the thermometer, ascending from January to July at Brussels, 
and uniformly descending from that month till December, is observed to be ac- 
companied by a progressive line, denoting the intensity of births in an inverse 
order to the above; beginning from February, which is the highest, and ending 
in July, when the number of births is the least. It then ascends till December, 
following an opposite course to the thermometrical line. 

99. Medical Profession in St. Petersburgh. — Dr. Granville informs us in 
his Journal of Travels to and from St. Petersburgh that the police of the medical 
profession is placed upon a very judicious footing in St. Petersburgh. No me- 
dical man, let his rank be what it may, can settle and practice in that city with- 
out having undergone a proper examination, and a list of all persons authorized 
to practice is printed yearly. A pharmacien, or " Aptekare," dares not make 
up a prescription of any practitioner, whose name does not appear in the print- 
ed list, and still less can he venture to sell a drug, in however small a quantity, 
or however insignificant its nature, without a prescription regularly signed. 
Every prescription must be signed with the name of the physician whose ad- 
vice has been taken, and must also mention the patient for whom it is written, 
with the day of the month and year. To the medicine a label is affixed, men- 
tioning the date and hour of delivery, its price and the name of the " Aptekare," 
and his shop; and even the most simple medicine must be sealed. The laws 
against professed quacks are generally put in force with great strictness. The 
surveillance of the medical profession, and of its rights and privileges, is con- 
fided in a particular manner to the minister of the home department, who is as- 
sisted by a council of medical men, one of the attributes of which council is to 
inquire into the rights to practice claimed by individuals, and to report to the 
minister any infraction of the established law respecting the regulation of the 
practice of medicine, as well as the existence of any empirical impostor. By an 
ukase of the late Emperor, who wished to encourage the higher branches of 
education in medicine, persons who have obtained the degree of M. D. are at 
once admitted into one of the thirteen classes of nobility. 

100. Duration of Human Life in Russia. — Cases of longevity are not only 
much more common, but also more extraordinary in respect to a greater dura- 
tion, in Russia than in any other part of Europe; thus, from the report of the 
holy synod, published in 1827, it appears that there were living in 1825, among 
those who professed the Greco-Russian religion throughout the empire, not 
fewer than 848 males who were 100 and more years old; among whom, 32 had 
passed the age of 120, 4 were between 125 and 130, and 4 others between 130 
and 135 years of age. Out of 606,881 males who died in 1826, 2785 had passed 
the age of 90 years; 1432 that of 95; and 818 that of 100. Among the latter, 
38 were more than 115 years of age; 24 more than 120; 7 more than 125; and 
one was 160 years old at his death. — Lond. Med. Gaz. Dec. 1828. 

101. Maison des Enfans trouvis at St. Petersburgh. — Dr. Granville states, on 
the authority of Dr. Kuhlwur, the superintending physician, that the mortality in 
this institution, among the children, within the first six weeks, is from thirty to 
forty per cent. — Granville's Travels to and from St. Petersburgh. 

102. Infirmary for Diseases of the Eyes at St. Petersburgh. — This institution was 
established in May, 1824, and was supported from its very onset by the whole 
of the imperial family. The progressive increase of its operations and income, 
during the short time that has elapsed since its origin, is quite extraordinary in 
the annals of medical charities. In the second year of its existence the received 
income amounted to 48,734 roubles, and the number of patients treated was 
11,783, of whom 3853 were new, and 273 were admitted as in patients; the 



» Miscellaneous. 255 

number of important operations performed was 464. During the third year the 
total income was 169,422 roubles, and the number of patients treated 15,079, 
4794 of whom were new, 340 were lodged and boarded in the Infirmary, and 
445 important operations were performed. — Ibid. 

103. Bristol Infirmary for Diseases of the Eye. — This institution, we believe, 
was established by Mr. Estlin, the very intelligent surgeon of Bristol 5 and we 
notice it on the present occasion to call the attention of our readers to the pro- 
digious benefits which may be conferred on the public, at very moderate ex- 
pense, by judicious management. An average number of 680 patients have 
been admitted annually; the whole expense not exceeding 40/. per annum. 
That the medicines for such a number, many of whom it appears were in at- 
tendance for several months, should not have amounted to a larger sum, ap- 
pears extraordinary; but when we learn that besides this, the house-rent, and 
other incidental expenses are included, and even that some patients from a 
distance have been maintained while under operations, it affords the most 
striking illustration we have met with of a maximum of benefit and a minimum 
of expenditure. — London Medical Gazette, December, 1828. 

104. Mode of Preserving Specimens of Morbid Anatomy. By John S. Gaskoiis-. — 
Mr. Gaskoin recommends the following means for preserving the appearances 
of diseased parts: — " Having removed the diseased part from the body, it should 
be as little handled or dissected as possible, especially when the effects of in- 
flammation, congestion, he. are to be preserved, as the blood may be pressed 
from, or disturbed in, the minute vessels. Let the blood which may have 
escaped from cut vessels, be gently washed off from the surface by a solution 
of the muriate of ammonia, or be absorbed by a soft sponge, lightly applied. 
The part should then be wrapped with care in old linen, and be so immersed 
in one part of a saturated solution of the muriate of ammonia, (sal ammonia of 
commerce,) and two of rectified spirit of wine. After two or three days the linen 
may be removed, and the part restored to the fluid. 

" Should the preparation be large, or, from the nature of the disease, contain 
a large quantity of aqueous fluid, then an additional portion of the muriate of 
ammonia in powder should be added, to meet the excess of aqueous men- 
struum. 

" The time necessary for maceration will mainly depend upon the size of the 
part to be preserved; but, generally, from ten to fifteen days will be found to 
be sufficient, although nothing can be lost by an extension of that time. Being 
taken from the macerating fluid, it should be again washed in a solution of the 
muriate of ammonia, then dissected as much as requisite, and be * put up* at 
once, in equal quantities of a saturated solution of the above salt in distilled water 
and rectified spirit of wine. I should observe that, in these proportions, the part 
is somewhat corrugated, which is not the case if one-third of the saline solution 
be used with two of the spirit; yet, in the former quantities, I have some reason 
to think the appearances of disease may be more securely preserved." 

This solution, he says, seems to have the property of fixing the blood in the 
extreme ramifications, without constringing the vessels themselves; while rec- 
tified spirit corrugating the delicate membranes of the minutest vessels, repels 
their contents into the larger, the thicker coats of which are easily acted on, 
and thus reduces the appearances of inflammation, &c. — Ibid. 

105. Supposed Change of Climate. — " Professor Schouw, of Copenhagen, has 
argued plausibly against the opinion that certain climates have changed in the 
lapse of ages. The date tree, for instance, he says, requires a mean tempera- 
ture of 78° Fahr. to bring its fruit to perfection; and it is as successfully culti- 
vated in Palestine now as it was in the earliest times, of which he gives interest- 
ing notices. Jerico was called Palm town; and Deborah's palm tree was men- 
tioned between Rama and Bethel. Pliny mentions the palm tree as being fre- 



256 QUARTERLY PERISCOPE. 

quent in Judea, and chiefly about Jerico. Tacitus, Josephus, Strabo, Diodo- 
ras Siculus, and Theophrastus, all speak of woods of palm trees there; and on 
the Hebrew coins date trees are by no means rare, and are easily recognised by 
their fruit." — Magazine of Natural History, January, 1829, from Oken's Isis. 

106. Epidemic at Paris. — An extraordinaiy epidemic made its appearance in 
Paris about the commencement of June, 1828, in several parts of the city simul- 
taneously, the nature and causes of which excited great attention among the me- 
dical men of that place. The principal symptoms were a diminution of sensibility 
and mobility in the extremities, accompanied with an itching or pricking sensa- 
tion in these parts, sometimes attended with swelling and redness, and gene- 
rally preceded by nausea, vomiting, and diarrhoea. The pain of the extremities 
was in many cases excessive, causing a total deprivation of sleep. The disease 
usually commenced with some derangement of the digestive organs, as anorexia, 
nausea, vomiting, and diarrhoea; in some patients these symptoms were so vio- 
lent, that they supposed that they were poisoned; in general, however, they 
were slight. After these gastric symptoms have continued some time, (from a 
few days to two weeks,) they slowly disappear, and are succeeded by a series 
of other phenomena. The face becomes red, swelled, and painful, and is the 
seat of an uncomfortable pricking sensation. This is not as common as affections 
of the extremities. These parts are almost always red and swelled, and the pa- 
tients experience various sensations in them, as prickings as if with needles, 
itching, lancinating pains, especially in the feet and hands. These symptoms 
are most violent in the lower extremities. The swelling was not constant; when 
it did exist it was sometimes accompanied with redness, resembling that of ery- 
thema or erysipelas; at other times there was no redness, in which case the 
swelling was like that of oedema. With these symptoms there was a marked 
diminution of sensibility, the patients lost in a great measure their perception 
of objects by the touch. The progress of this disease was extremely slow, and 
its duration of course very long; some patients were under treatment four and 
five months. In most cases the symptoms gradually declined in severity, mo- 
tion and sensibility returned, the erythematous redness and swelling disappear- 
ed, the epidermis became detached in large plates or scales, but the patients 
still experienced a feeling of heaviness and stiffness in their limbs. Dissection 
revealed no morbid changes to which these symptoms could be attributed. The 
causes of this epidemic are yet unknown, though a variety of theories have 
been framed respecting it. It generally occurred in the lower classes of per- 
sons who are badly nourished, and live in low and damp habitations. Some 
physicians, as Ratier and Cayol, thought it was analogous to the disease pro- 
duced by the ergot, others to the colica pictonum. M. Broussais says it is a 
common disease, being an erysipelas combined with gastro-enteritis. Alibert 
says that it is erysipelas, and some again that it is a modification of pellagra. 
The treatment of course was various and vacillating; the most successful, how- 
ever, is said to have been that used in the Charite" for colica pictonum, viz. sul- 
phurous baths and douches. — Revue Medicate. Dec. 1828, and Bulletin des Sci- 
ences Medicates, Nov. 1828. 



( 257 ) 



AMERICAN INTELLIGENCE. 



A Case of the deleterious effects of Opium on an Infant. By C. Drake, M. D. of 
New York. — Some years ago I witnessed a remarkable recovery from the ill 
effects of opium, which may be considered interesting* in some of its particulars. 
The case shows how small a quantity of this drug may produce deleterious ef- 
fects on the infant system; the efficacy of cutaneous stimulation by means that 
can almost always be readily commanded, and are less exceptionable than such 
as are commonly resorted to under these circumstances; and it besides inculcates 
the propriety of the physician almost never despairing of recovery in these 
cases, or of relaxing his efforts as long as there are any remains of life. 

Whilst on a visit to a relative in a neighbouring city, in the summer of 1815, 
I was requested about 6 P. M. to see the infant of a next door neighbour, aged 
about fourteen months, to whom the mother, about half an hour before, had 
given a dose of paregoric for some trifling catarrhal affection. The mother had 
become alarmed, fearing she had given too large a quantity of the medicine, as 
she observed the child to breathe somewhat unnaturally, and was aroused from 
its sleep with some difficulty. She assured me that she had given it only the 
half of a tea-spoonful of some paregoric she showed me, and which she had ob- 
tained from a neighbour whom she knew was taking it under the direction of a 
physician. I did not imagine that so small a quantity could produce any unplea- 
sant consequences, but in order to allay her apprehensions, and as the child's 
previous indisposition indicated the propriety of the measure, I administered in 
divided doses, fifteen grains of ipecacuanha, which I happened to have in my 
pocket. Finding the medicine not likely to operate, I sent for more emetic 
medicine, and requested that 1 might be relieved from the care of the case by 
the family physician. He arrived in a few minutes, and took charge of the pa- 
tient. I was again requested between ten and eleven o'clock to visit the child. 
I found that three or four physicians had been in attendance — that they had 
faithfully plied the most approved means without relief, had ceased further ef- 
forts as hopeless, and retired leaving only the family physician. The nurse was 
holding the child on a pillow, before an open window, for the benefit of the 
fresh air. Its skin was pale, cold, and covered with moisture; its respiration 
short, quick, stertorous, and attended with loud rattle, threatening speedy dis- 
solution. I agreed with the gentleman in attendance that the child would not 
at furthest live more than an hour, and that it was useless to make trial of any 
additional means. Having a midwifery case on hand that required his attend- 
ance, he requested he might be permitted to retire, as he could be of no further 
service to the child; to which the parent replied, that if the doctors would only 
make one effort more he would be satisfied, and they might leave. At the mo- 
ment I happened to cast my eye on a bottle of Cayenne pepper standing on the 
sideboard, and proposed to make a hot cataplasm of it to be applied to the abdo- 
men, to which the doctor readily assented. Instantly the pepper and mustard 
were mixed into a cataplasm with brandy and applied over the child's abdomen; 
similar ones applied to the feet and hands, and the child wrapped warm in its 
cradle. We now left the house, believing the child would shortly expire. At 
about twelve o'clock, perhaps forty or fifty minutes after applying the sina- 
pisms, a messenger requested me to hasten to the house, as the child had been 
seized with a convulsion, and perhaps something might be done. On entering 
the room, I saw to my astonishment, the child sitting up on the nurse's lap, pale, 
haggard, and with drooping head, but breathing naturally, and recovered from 

No. VII.— May, 1829. 33 



253 QUARTERLY PERISCOPE. 

the poisonous effects of the opium. The sinapisms were instantly removed, and 
the parts they covered found of a bright red. The child was well washed in a 
warm bath to remove any adhering" particles of the application; took some liquid 
nourishment, with a small quantity of wine in it, and composed in its cradle to 
rest. The next morning I had the satisfaction to find the little patient merely 
languid and enfeebled from the last night's accident. 

On inquiry of the physician, from whom the paregoric was obtained, he told 
me that he was in the habit of making his paregoric of four times the common 
strength, for he saw no reason why so much spirits should contain so little 
opium. Admitting then that the child took, from a miscalculation of the mother, 
nearly a tea-spoonful, it could not at most have taken more than a grain of opium, 
and probably somewhat less. Let this case be a warning to physicians how they 
vary from the standard directions in preparing the officinal medicines. 

It may be thought by some, and I am myself inclined to the opinion, that this 
unexpected recovery, under the most desperate circumstances, is in a great 
measure to be attributed to the small quantity of opium taken, and that the ex- 
ternal stimulation prolonged the vital action until the deleterious powers of the 
poison were expended. Under this view, then, the use of such remedies is of 
the utmost importance, and the case, moreover, shows that it is never too late 
to attempt the removal of the narcotic poison by means of the stomach pump, 
if there be the slightest indications of life remaining. 

Pyroligneous Mid in Sphacelus, and Foetid Ulcers. — Dr. Thomas Y. Stmons, 
of Charleston, has favoured us with the first Number of the Carolina Journal of 
Medicine, &c. published in January, 1825, in which are some interesting ob- 
servations on the use of pyroligneous acid in sphacelus, and foetid ulcers. The 
first case in which Dr. S. applied the acid was in one of mortification of the scro- 
tum and perineum from infiltration of urine. ',« One portion of the acid diluted 
with six parts of water was applied constantly to the sloughing surface. In 
twenty-four hours a line of demarcation was observed. In a day or two more 
the mortified surface separated, and healthy granulations appeared." Dr. S. 
has since "been called in consultation to a case, where the penis was much tu- 
mefied and gangrenous, arising from destruction of part of the urethra, and in- 
filtration of urine into the cellular texture. The pyroligneous acid wash was 
applied. In two days the sphacelus separated, and a healthy granulation took 
place." Dr. S. recommends this application "in every case of sphacelus, as 
well as of foetid ulcers." Dr. S. also writes to us that he has found it "infinitely 
superior to any other means in phagedenic ulcers — and in preventing the pro- 
gress of mortification." 

Our readers may recollect that it was used by Dr. Horner in the case of Wag- 
goner, (See Vol. III. p. 92,) with apparent benefit. We have used it in caries 
of the bones of the ear with much advantage. The powers of this article are 
worthy of further investigation. 

Case of Injury of the Head. By J. W. Het/stis, M. D. of Alabama. — A negro 
girl, about ten years of age, belonging to Mr. M. R. on ascending a hill 
with a pail of water, fell and struck the side of her head against a projecting 
slab. Her master, upon examining the wound, from its trivial appearance, paid 
but little attention to it, and ordered his negro nurse to dress it. The girl ap- 
peared to suffer but little inconvenience for several days, and pursued her or- 
dinary business, making no complaint, and evidently in good health. In about 
a week after the accident she became indisposed, was confined to her bed, and 
was said to be attacked with fever. I was at this time in attendance on several 
of the white children of Mr. R.'s family, who were sick with the influenza. As 
the negro girl continued to grow worse, Mr. R. requested me to walk and see 
her. He observed that subsequently to receiving the injury I have mentioned, 
she was attacked with fever, for which she had been treated by them in their 
usual way, judging that the fever was her sole complaint. Upon examination 



American Intelligence. 259 

i found her in a state of much debility; derangement of intellect; pulse small, 
frequent, irregular, and intermitting: when particularly interrogated as to the 
seat of her pain, she would apply her hand to the wounded part of her head. The 
wound was small, and just sufficient to enable me to see a small portion of the 
skull, which appeared white, and divested of its periosteum. I immediately ob- 
served that there was a collection of matter beneath the skull, and that the 
only chance for the child's recovery was from the operation of trephining. As 
I was then a distance from home, the operation was postponed two days, before 
I procured my instruments, when I proceeded to perforate the cranium. The 
injury was received just above and behind the left ear, near the posterior and 
inferior angle of the parietal bone; in this place I, accordingly, dissected up the 
integuments, and applied the trephine. Through the opening in the cranium 
thus made, there was a very profuse discharge of offensive matter. After which 
the patient's intellect returned, and she was able to speak with her ordinary in- 
telligence. She remained much relieved for twenty -four hours; after which she 
was seized with fever, and pain in the fore part of the head; for which, on my 
next visit, I directed a cathartic, and an epispastic to the affected part. The 
blister succeeded in mitigating, or removing the pain, (for the dread of the 
knife might, very probably, cause her to conceal her feelings,) but the fever 
still continued, though not severe nor constant, being worse every other day, 
with remissions of twelve or fourteen hours continuance. For the mitigation 
of these febrile paroxysms, I directed the bowels to be kept open by the occa- 
sional use of Epsom salts, and the use of cream of tartar during the fever: in the 
intervals quinine was given to invigorate the debilitated constitution. After the 
operation, the matter continued to flow from the head for a day or two, and 
then stopped; she then became subject to daily exacerbations of fever for the 
space of nearly three weeks, and at times her symptoms assumed the most 
threatening aspect. At the end of the time just mentioned, however, the 
wound again commenced running, and from this period she began rapidly to 
improve, and finally recovered. 

Case of Deformed Pelvis, in which Delivery was successfully effected, Embryulcia 
having been performed in two preceding pregnancies. By William M. Fahste- 
stock, M. D. — On the 20th of October, 1825, I was requested to visit Mrs. A. 
of Manayunk, then in her third parturition. Her former labours were truly dis- 
tressing and unfortunate, suffering the pains and racks of a powerful uterus and 
vigorous system eight and forty to sixty hours, and then being obliged in both 
instances to submit to embryulcia, under the impression of a deformity existing 
so as to prevent the expulsion of the offspring; and her physician deemed it his 
duty on the last occasion to advise her to avoid the recurrence of so unpleasant 
an expedient, and the jeopardy of her life, which she incurred in this condition 
by denying herself the lawful gratification of the connubial state. Her children 
were very large, partaking of the structure of the mother, who is short, and 
extremely lusty; and she was further assured that the conformation of the pelvis 
would not even admit of giving birth to a child of the most ordinary size. The 
admonition, however, as may be supposed, was not regarded, and she had ar- 
rived at the full period, and been two hours in labour when I was first consult- 
ed. I was apprised of her critical situation, and prepared myself to meet and 
encounter the most painful emergency. On examination, the deformity was 
discovered, but ample capacity also for the passage of the child. The deformity 
would have been sufficient in this presentation, which was the first, and natu- 
rally the best, to impede the descent into the pelvic cavity. There was but little 
contraction of the straits, excepting reverse of position, the greater diameter be- 
ing the antero-posterior, and the lesser at the inferior strait being the sacro-pubic. 

After congratulating the distressed sufferer, and encouraging her to fortitude 
at the prospect of being a happy mother, I proceeded to change the head from 
the first to the third position, premising the operation by an injection to eva- 
cuate the rectum. Having obtained advantage of the greater diameter, it rea- 



260 QUARTERLY PERISCOPE. 

dily passed down to the junction of the sacrum and coccyx, where it was again 
arrested? presenting the great diameter of the head to the smaller of the infe- 
rior strait. This was remedied by making another change, which gave it a 
transverse direction to the natural position at this point in a healthy pelvis, and 
obliged the occiput to escape beneath the tuberosity of the ischium. In twenty 
minutes after I entered the chamber, I had the extreme felicity of presenting 
the delighted family with a living female child of extraordinary dimensions. 
The sequel was mild and as favourable as could be desired. I shall only add 
in relation to the patient, that I had the happiness of conducting her safely 
through another labour on the 12th of the following September, ten months 
and twenty-three days afterwards. It may also be proper to remark, that the 
patient reared the infant at her breast until the quickening of the second child. 

Medical Statistics. By I. Hats, M. D.—The mortality during the early periods 
of life is usually so great that the following facts are worthy of being recorded. 
During a period of three years and eleven months, ending 1st of January last, 
no death occurred among the children in the Philadelphia Orphan Asylum; on 
the 1st of January there was one death; none since then up to April 20th, mak- 
ing only one death in four years and four months nearly. Children are admitted 
into this institution from the earliest infancy, boys to the age of five, and girls 
to that of six years, provided they are not suffering, at the time of their admis- 
sion, from any contagious or incurable disease, and they are retained until 
twelve years of age. The number of children during the last four years has 
averaged about one hundred; sometimes there has been eight or ten less, at 
others as many more. The asylum is situated at the north-western part of the 
city plot, and there are very few houses in the immediate vicinity. This dis- 
trict has been for the last few years much affected with intermittent fever, and 
during the last summer only four of the children in the asylum escaped the dis- 
ease, and some have had repeated attacks of it. 

On the Employment of Cotton as a Dressing for Blisters. — Dr. A. P. Mehhill, 
of Natchez, Mississippi, in a communication in the North American Medical and 
Surgical Journal, for April last, recommends the employment of cotton as a 
dressing to blisters, "Blisters," says he, "that are not required to be kept 
discharging for any length of time, are readily healed by the application of 
finely carded cotton, as in cases of vesication from burns. The cotton should 
be applied as soon as the vesicating plaster is removed, half an inch or more in 
thickness, and sufficiently large to ensure the complete absorption of the dis- 
charge. In two days, under ordinary circumstances, a new cuticle will be form- 
ed and the blister cured. This dressing gives no pain, and may be adopted 
with particular advantage in dressing blisters upon the nucha, when the pa- 
tient is confined in bed, and also for persons who are not confinedby indisposition; 
as blistered surfaces, when dressed in this manner, give so little inconvenience 
as not to interfere with the motions of the body in common exercise." 

Case of Preternatural Membrane in the Vagina. By William Hall Richard- 
son, M. D. Professor of Obstetrics in Transylvania University. — This was the 
case of a woman in labour with her third child, the delivery being prevented 
by a membranous septum across the vagina. In the centre of this septum there 
was a small hole, capable of admitting the blunt end of a small probe, through 
which the waters were discharged. The membrane was divided, and the wo- 
man safely delivered. The previous history of the woman afforded no clue to 
the causes of the formation of this septum. Her previous labours had been 
tedious. — The Transylvania Journal of Medicine, Feb. 1829. 

Account of the Dengue as it prevailed at Antigua, West Indies. By Thomas 
Nicholsow, Surgeon. — We have taken some pains to furnish our readers with 
all the information we could collect, respecting this epidemic, inasmuch as 






•American Intelligence. 261 

many of them may be called on to treat it, as it appears still to be extending 
itself. The following description of it as it appeared in Antigua, is from the 
Edinburgh Medical and Surgical Journal for January last. The disease made its 
first appearance at Antigua, in January, 1828, and during this and the succeed- 
ing month, prevailed to such an extent that very few of the inhabitants of St. 
John's escaped. 

The attack was usually ushered in by an " intense head-ache, with flushed 
face, pains in the back, wrists, and ankles, a weariness in the limbs, and great 
prostration of strength. Flexion of the finger-joints was performed with diffi- 
culty and pain. The skin was hot, but rather moist, and acutely sensible of the 
impressions of the external air, from which the patient shrunk under a load of 
bed-clothes, quite unusual in a tropical climate. The stomach was generally 
irritable at the commencement of the attack, and the auction of vomiting in- 
creased the violence of the head-ache, which at this period of the disease was 
always the most urgent symptom. In the course of thirty-six or forty-eight 
hours the febrile symptoms abated, and on the third day the patient probably 
left his bed free from complaint; but on the fourth, or from that to the eighth 
day, the eruption, in a great majority of the cases, made its appearance. 

** The first symptom of this occurrence consisted in the patient complaining 
of a pricking sensation in the soles of the feet and palms of the hands. These 
became swollen, and presented a number of red points, which became gradu- 
ally diffused over the whole body in the form of wheals or papulae, and accom- 
panied with excruciating pains of a rheumatic character. The eruption disap- 
peared in the course of twenty-four hours, and was followed in a few days by 
desquamation of the cuticle. In those cases in which the eruption was distinct, 
the pains usually vanish with it, leaving only a little oedematous swelling of the 
ankles. But in others, and these were usually not attended with the eruption, 
the pains continued with exacerbations and remissions for several weeks, nay 
months. The patient was rendered incapable of walking; and the fingers were 
often so much swollen, as to preclude the possibility of his following any manual 
occupation. 

*' Such was the general progress of the disease as observed in several hun- 
dred cases which I attended in this island. In its attack and general progress 
it bore a striking resemblance to influenza, whilst the eruption resembled that 
of measles; but in no instance that has come to my notice was it accompanied 
with catarrhal symptoms. Like the other exanthems, I am inclined to think 
that it was of a contagious nature. Its slow and gradual progress from one fa- 
mily to another, and from St. Thomas and St. Bartholomew, the chief mart of 
the Caribbean Islands, to all the colonies holding intercourse with them, its 
prevalence at very different seasons, and different states of the thermometer and 
hygrometer, lead me to suppose that it originated from a specific miasm, rather 
than from atmospheric influences only. 

" The treatment may be summed up in a few words. Brisk purgatives, sa- 
line diaphoretics, the warm bath, or pediluvium, formed the chief remedial 
measures during the febrile stage; and the cold affusion, followed by friction 
with dry flannel, or some rubefacient liniment, was found most effectual in 
relieving the sequelae of the disease. At the commencement of the epidemic, 
blood-letting was had recourse to; but the head-ache was not relieved by this 
measure, and the convalescence was rendered more tedious. In one case only, 
which was ushered in with epileptic convulsions, bleeding from the temporal 
artery seemed to do good. None of the cases that came under my observation 
proved fatal; nor do I believe any instance of death from this epidemic ever oc- 
curred in this island. 

" In your ninety-fourth number, p. 172, 1 observe that an epidemic fever si- 
milar in its attack to that under consideration prevailed in Calcutta and Ber- 
hampore in 1824 and 1825; and in the third volume of the Edinburgh Journal 
of Medical Science, p. 229, Mr. Orr describes a similar epidemic which was 
prevalent on board the Asia in February and March, 1825. The latter does 



262 QUARTERLY PERISCOPE. 

not appear to have been accompanied by any eruption; and the former, though 
attended with an inflammatory blush or papulae during- the febrile stage, was 
not followed by the severe arthritic pains which characterized the epidemic of 
the West Indies." 

On the Use of Opium in Inflammatory Diseases. By F. G. King, M. D. of New 
York. Communicated in a letter to Professor V. Mott. — " In reply to your in- 
quires as to the use of anodynes and opium by the late Dr. Post, I have to remark, 
that in conversation with him some two years past, relative to Dr. Armstrong's 
practice in inflammatory diseases, he told me that the use of opium, as recommend- 
ed by that gentleman, (except in larger doses, J was corroborated by his own ex- 
perience for a long series of years, and that to him it was by no means a novelty: 
for that in 1804, he was called to a child about three years of age, suffering un- 
der a violent pneumonic attack, accompanied by pain, cough, and great febrile 
excitement. That he accordingly bled, blistered, and evacuated the patient, 
afterwards placing him under the use of antimonials, but all without benefit. 
Matters proceeded from bad to worse, until the child, exhausted by constant 
cough and excessive restlessness, seemed nearly at the point of death. Under 
these circumstances, he determined to quiet all these irritating symptoms by a 
powerful anodyne, and accordingly exhibited sixty drops of laudanum. Two 
hours after, he was called to the child, then supposed by its parents to be dying. 
He found the features sunken, the surface covered with a cold clammy sweat, 
and secretions of an unpleasant appearance about the eyes and nostrils, but the 
pulse had diminished in frequency, and was more full; the respiration was slower, 
and every thing indicated the full and desired action of the anodyne. The pa- 
rents were astonished to hear the physician say that the child would soon be bet- 
ter. The next morning all untoward symptoms had subsided, and the child be- 
came rapidly convalescent and recovered. 

" This was his first trial of anodynes in such affections; his experiment, if you 
please; but a few months afterwards, a similar case occurring, he immediately 
resorted to the anodyne; depletion and evacuants having been premised, and 
with similar success, since which period he has generally continued that mode 
of practice; latterly, however, substituting the Dover's powder in place of lau- 
danum, in pneumonic attacks. 

"In 1810, he was called in consultation upon a gentleman in Jersey, suffer- 
ing under enteritis. He found that he had been repeatedly bled, blistered, and 
evacuated, but to no advantage; the pain still continued acute; the pulse was 
small, frequent, and corded: the skin dry and hot. Under these circumstances 
he suggested the propriety of exhibiting a powerful anodyne, in order to quiet 
all irritation, and give nature an opportunity of recovering herself. After a lit- 
tle hesitation on the part of the attending physician, it was finally determined 
to adopt the course proposed, and one hundred drops of laudanum were direct- 
ed; an hour elapsed — no sensible effect having been produced, when the dose was 
repeated, and in half an hour the patient was under its full influence. He awoke 
the next day free from pain or tenderness, and so recovered. The same gentle- 
man has been frequently attacked since with the same affection, and uniformly 
after being bled and evacuated, he has recourse to his anodyne, which rarely 
fails to quell the disease. But to be efficacious, the dose must be heroic, at least 
such was the opinion of Dr. Post, who often remarked that practitioners, espe- 
cially in England and France, were not aware of the value of opium in inflam- 
matory diseases, for even when employing it in such cases, their doses were too 
trivial to exert any marked influence over the malady. He himself always ex- 
hibited it under the opinion, that to obtain its soothing' effect upon the system, 
and its paralyzing influence over the disease, it must be given in large doses. 
In diarrhoea and certain conditions of dysentery, after having cleansed the pas- 
sages, he employed laudanum or Dover's powder with the happiest effect; in 
fact, he rarely used much else than salts and Dover's powder in diarrhoea, in 
adults. In his own case he was no less prodigal of anodynes than with his pa- 



American Intelligence. 263 

tlents. Being, as you well know, for many years a constant prey to pleuritic 
affections, his treatment of himself was short and efficacious, viz. blisters and 
purgatives, followed by eighty or one hundred drops of laudanum, which quiet- 
ed his cough — allayed pain, and soon placed him in a condition to resume his 
business. 

"In conclusion, permit me to state an occurrence which took place under 
my own eyes, two years previous to his death. He was then violently attacked 
with pleurisy, accompanied with much fever, for which he had been purged 
and blistered, and at the period in question, was under the use of antimoniais. 
At this time he directed me to give him seventy drops of laudanum. I remon- 
strated, directing his attention to the dryness of his skin, its increased heat, and 
the frequency and hardness of his pulse. His answer was, 'believe in my ex- 
perience rather than in your theory; give me seventy or eighty drops of lauda- 
num, and an hour will convince you of its propriety.' It was given, and within 
the hour his pulse became calm, full, and slow; his skin was covered with a 
gentle perspiration, and his condition strikingly improved. He left his bed the 
next day, and frequently since has said to me, ' I think I have given you a clini- 
cal lecture that you will remember/ " 

Gunshot Wound of the Lungs and Heart. — Dr. Leonard Randal of Tennes- 
see relates in our cotemporary, the Western Journal of the Medical and Phy- 
sical Sciences, a novel and very interesting case of this kind. A negro boy, 
aged fifteen, was accidentally shot, April 5th, 1828, with a fowling-piece. 
When the gun was discharged, the boy was but six feet from its muzzle, and 
the whole charge of shot entered on the left side of the sternum about an inch 
and a half below its lower extremity. He fell to the ground immediately, his 
pulse became scarcely perceptible, and his breathing difficult; the haemorrhage 
was not profuse. He soon expectorated blood freely, and on a dose of oil being 
given him, he vomited, rejecting with the oil a large quantity of wind. On the 
morning of the 7th of April he became extremely restless, his pulse was weak 
and intermittent, syncope came on, and he appeared dying; stimulants were 
given, and he revived. In the afternoon his bowels were opened by medicine 
which had been given in the morning, and he seemed much better. 

April 8th. In the morning much better; afternoon fever, pain in the breast, 
cedematous swellings of feet and legs. Next morning, (9th,) the wound began. 
to slough, he was restless, his pulse very weak, frequent, and intermitting, ex- 
tremities cold, bloody expectoration, respiration difficult. The next afternoon 
considerable fever. " April 11th. The wound had sloughed so considerably as 
to form a hole into the thorax, two-thirds of an inch in diameter." On the 12th, 
the wound put on a healthy appearance and began to granulate; it afterwards 
continued to heal, " and in three or four weaks was completely cicatrized; the 
cedematous swelling of the lower extremities disappeared in a week or two after 
the last date, and although extremely emaciated, he was able to walk about, 
and had many appearances of getting well. When in this promising condition, 
he relapsed, apparently from indulging himself too freely in a meal of strong 
diet. From this relapse he did not recover, a hectic fever supervened, and he 
died on the night of the 11th of June, sixty-seven days after the accident." 

On examination of the body by Dr. Eandal, assisted by Dr. Hudspeth, who had 
attended the patient with Dr. R. they found, several shot lodged against the 
ribs — the membranous covering of the ribs and cartilages inflamed; part of the 
pericardium adhering to the surface of the heart; the left lobe of the lungs in- 
flamed and adhering to the pleura, and lodged in various parts of the sub- 
stance of the former, a number of shot. The right lobe nearly obliterated, 
dense, its cellular substance entirely lost, a small portion of serum in the pleura. 
The heart was considerably enlarged, its parietes in some parts nearly cartila- 
ginous, and in the cavity of the right ventricle there were lying loose three shot. 
" This ventricle was greatly enlarged, and lined with a thick coat from which 
there projected numerous papillae of a dun colour, giving it the appearance of 



264 QUARTERLY PERISCOPE. 

the upper surface of the tongue of an ox. On opening the right auricle, we 
found two shot in its cavity, also lying detached. The internal surface of the 
auricle did not appear to have sustained much injury from their presence. The 
shot had entered the heart about one-third of the way from its base to its apex, 
the wounds made by them were at a little distance from each other; they had 
all cicatrized, but the spots were plainly to be seen. In the cavity of the peri- 
toneum, as in that of the pleura, there was a small quantity of effused serum. 
The liver appeared to be somewhat enlarged, but not otherwise much diseased, 
except about the gall-bladder and its duct, where there were some gangrenous 
appearances, and part of the colon was also gangrenous." 

Professor Mottfs Biographical Memoir of Wright Post, M. D. — By the unani- 
mous request of the Medical Faculty and Students of Rutgers College, Profes- 
sor Mott has published his excellent Biographical Memoir of Wright Post, M. 
D. late Professor of Anatomy and Physiology, and President of the College of 
Physicians and Surgeons in the City of New York. This memoir forms an in- 
teresting addition to the medical history of our country. 

Dunbar's Essay on the Structure, Functions, and Diseases of the Nervous Sys- 
tem. — This is an inaugural dissertation, presented in March, 1828, for the de- 
gree of M. D. It contains a very good sketch of the present state of knowledge 
respecting the nervous system, and is highly creditable to the author, John R. 
W. Dunbar, M. D. of Virginia. Originality is not usually the merit of an inau- 
gural thesis, and this does not lay claims to such; but it displays much industry 
and research, and the credit is due to the author of restoring to Bartholinus the 
honour of some anatomical discoveries, which have generally been attributed 
to modern anatomists. 

The Western Journal of the Medical and Physical Sciences. — Dr. Daniei, 
Drake has become sole editor and proprietor of this work, and proposes to be- 
stow upon it all the time and attention that can be spared from his professional 
duties; we wish him success. He has adopted, we believe, the most effectual 
means to secure this, in offering a remuneration to contributors. He offers — 

" I. A receipt for the year's subscription to the Journal, for every paper, of 
not less than four pages, which shall be deemed worthy of insertion. 

"II. One dollar a page, for every communication, exceeding four pages, 
which may, from its merits, be entitled to publication. 

"III. A premium of fifty dollars, for the best dissertation on each of the fol- 
lowing topics: — 

" 1. The general principles of the pathology and treatment of the diseases 
of the negroes of the Southern States; with a particular application of them to 
the malady generally denominated Negro Consumption; reference being con- 
stantly had to the constitutions and diseases of the whites of the same region as 
standards of comparison. 

" 2. The treatment of autumnal fever on the principles of Broussais; with a 
comparative estimate of the success of -that plan, and the one previously pur- 
sued, illustrated by original cases. 

"3. The remote cause and morbid anatomy of the disease denominated in 
the Western country the * Sick Stomachy with a successful discussion of the 
question, whether it is a new disorder. 

"4. The successful application of the process of Civiale, to the destruction 
of the calculus vesicae, established by American cases. 

" The dissertations to be accompanied, as is usual in such cases, by private 
letters containing the names of the authors; which letters will not be opened 
until a decision is made on the respective merits of their papers." 

A translation of Beclard's Elements of General Anatomy is preparing for the 
press. By Joseph Toono, M. D. 



American Intelligence. 



265 



UNIVERSITY OF PENNSYLVANIA. 

M a Medical Commencement, held March 9,1st, 1829, in the Saloon 
of the Masonic Hall, Chesnut street, the Degree of Doctor of Medi- 
cine was conferred upon the following Gentlemen, who had passed 
their examinations by the Medical Faculty. 



Nova Scotia. 
Edward L. Brown, . 

Island of Cuba. 
Joseph M. Urquiola, 

Rhode Island. 
Alexander P. Moore, . 

New York. 
Gilbert S. Fowler, . , 

Connecticut. 
Josiah Barnes, . . 
Caleb Ticknor, . . . 

Maine. 
Israel B. Bradley, . . 

New Jersey. 
Lewis Drake, . . 
Charles Higbee, . . 
Alison Ely Perrine, 
Robert J. Woodruff, 
James S. Carpenter, 
John H. Blackwell, . 
Joab W. Hunt, . . 

Pennsylvania. 
Richard K. H. Sims, 
Samuel Maclay, . . 
Robert R. Dorsey, . 
Daniel Lachenour, . 
Martin Weaver, . . 
Hugh Meredith, . . 
Richard Maris, . . 
Thomas Pritner, . . 
Samuel C. Merwin, . 
Esaias Kinzer, . . 
George Thomas, 
Henry D. Dietrich, . 
William Rinehart, . 
William L. Sterigere, 
George Halberstadt, 
Joseph Peace, . . 
James C. Kennedy, . 
Charles Huffnagle, . 
David M. Fort, . . 
Diller Luther, . . 
Joshua Y. Jones, 
William Irvin, . . 
John J. White, . . 
John Vaughan Smith, 
Edward H. Glentworth 
William N. Johnson, 

No. VII.— May, 



Subject or Thesis. 
Causes of Malignant Epidemics. 

Menstruation. 

Rubeola. 

Puerperal Fever. 

Spina Bifida. 

Influence of Diet, Dress, and Amusement upon 
Health. 



Csesarean Operation. 

Trachitis. 

Medical Electricity, Galvanism, and Magnetism. 

Accidental Uterine Hsemorrhage. 

Cause of Yellow Fever. 

Hepatitis. 

Morbid Effects of drinking Cold Water. 

Dysentery. 

Non-existence of Syphilitic Virus. 
Intermittent Fever. 

. Efficacy of Rest in Injuries of the Knee. 

• Ptyalism. 

, Dysentery. 

, Retrocedent Gout. 

, Articular Affections. 

, Lead Disease, 
Generation. 

. Position in Surgical Diseases. 

. Influence of Habit. 

. Haemoptysis. 

. Hepatitis. 

. Angina Pectoris. 

. Structure and Pathology of Mucms Membranes. 

. Delirium Tremens. 
Trachitis. 

. Dyspepsia. 

. Cholera Morbus. 

. Caries of the Spine. 

. Typhus Fever. 

. Gastritis. 
Circulation. 

. Gastritis. 
, . Jaundice. 

. . Music in Mental Diseases, 
1829. 34 



2G6 



QUARTERLY PERISCOPE. 



Joseph Togno, . . 
Charles Fronefield, . 
Henry Lippincott, . 
Joseph M. Heister, . 
Charles W. Duffield, 
Robert R. Reed, 
Henry Pettit, . . 
Horatio N. Morris, . 
Samuel J. Hobson, . 
George Powell, . . 
Ralph Hammersly, . 
Amos Pennebaker, . 
Aaron Torrence, 
Columbus C. Conwell, 

Delaware. 
Samuel Murphey, . 
Thomas F. Dale, 
Henry Gibbons, . . 

Maryland. 
Lyttleton M. Robertson, 
Albert R. Ober, . . . 

Virginia. 
Marvin R. Griswold, 
Orlando Fairfax, . . 
Joseph E. Cox, . 
James Milton Inge, . 
William Baylor, . . 
Cuthbert D. Barham, 
William H. Edwards, 
William Henry Shield, 
James S. Tunstall, . 
John N. Powell, . . 
Benjamin J. Harrison, 
William Smith, . . 
Peter H. Anderson, 
George J. Smith, 
Singleton Jones Cooke 
William E/Hardaway, 
Henry D. Magill, 
Conway Rollins Nutt, 
Henry K. Jones, 
John G. Williamson, 
William R. Smith, . 
Nicholas M. Sebrell, 
John D. Porter, . . 

North Carolina 
Michael D. Donnellan, 
Milo A. Giles, . . 
William P. Morgan, 
Nicholas L. B. Stith, 
John Wesley Potts, 

Thomas Davis, . . 

South Carolina 
William G. Adams, . 
Solomon Etting Myers, 
Thomas Hunt, . . 
Albert G. Goodwyn, 



Endosmosis and Exosmosis. 

Scrofula. 

Haemoptysis. 

Passions. 

Haemoptysis. 

Vital Functions and Mechanical Force. 

Hydrocephalus. 

Digestion. 

Iodine. 

Erysipelas. 



Respiration. 
Caries of the Spine. 
Vegetable Chemistry. 

Hepatitis. 

Diseases of the Alimentary Canal in Children. 

Varioloid. 

Menstruation. 
Diabetes. 

Dyspepsia. 

Acute Stage of Dysentery. 

Haemoptysis. 

Gastritis. 

Cholera Infantum. 

Haemoptysis. 

Cholera Infantum. 

Hepatitis. 

Gastritis. 

Uterine Haemorrhage. 

Diet in Convalescence. 

Tic Doloureux. 

Typhoid Fever of Amelia. 

Gastro Enteritis. 

Mechanism and Physiology of the Human Head. 

Gonorrhoea Virulenta. 

Haemoptysis. 

Bronchocele. 

Dysentery. 

Epilepsy. 

Anatomy and Functions of the Skin. 

Enteritis. 

Bilious Diseases of Rappahannock. 

Effects of Cold. 
Syphilis. 

Small Pox, and causes of failure in Vaccination. 
Dysenteria. 

Medical Topography and Autumnal Fever of Wash- 
ington, N. C. 
Dysentery. 

Chronic Dysentery. 
Dyspepsia. 

Pathology of Jaundice. 
Haemoptysis. 



American Intelligence. 



267 



Joel R. Adams, . . . . 

Martin Philips, . . . . 

Alabama. 

Fleming Jordan, . . . 

Henry S. Levert, . . . 

Georgia. 

Augustine Owen, . . . 

Clark D. Parks . . . . 

Thomas W. Ingram, . . 
John B. Wiley, .... 
District or Columbia. 

Thomas Miller, Jr. . . . 

Kentucky. 

Norborne A. Gait, . . . 

Ohio. 

EdsonB. Olds, . . . . 

Joab Wright, 

Louisiana. 

Edward R. Chew, . . . 

Frederick N. Ogden, . . 

Tennessee. 

Robert H. Rivers, . . . 

Total, 107. 



Haemorrhoids. 
Icterus. 

Hepatitis. 

Metallic Ligature of Arteries. 

Acute Bronchitis. 

Effects of Cold. 

Sanguiferous Circulation. 

Cold and Heat as Causes of Disease. 

Jaundice. 

Idiopathic Dyspepsia. 

Secale Cornutum. 

Medicinal Qualities of Water. 

Strictures of the Urethra. 
Gunshot Wounds of Intestines. 



Haemorrhoids. 



W. E. HORNER, Dean. 



On the same occasion the corner-stone of the New Medical Hall was laid by 
the Right Rev. William White, D. D. Bishop of Pennsylvania, and an inscrip- 
tion to the following effect, along with the list of Graduates, was deposited-, a 
suitable Address being delivered to the graduates and to the public, in the Ma- 
sonic Hall, by the Rev. William H. De Lancet, D. D. Provost, &c. 

UNIVERSITY OF PENNSYLVANIA. 

Trustees. 



The Governor of the State, ex officio, 

President of the Board. 
Rt. Rev. William White, D. D. 
Edward Burd. 
William Rawle, LL. D. 
Benjamin R. Morgan. 
James Gibson. 
Horace Binney, LL. D. 
William Meredith. 
Benjamin Chew. 
Rev. James P. Wilson, D. D. 
Robert Wain. 
John Sergeant, LL. D. 
Thomas Cadwalader. 



Nicholas Biddle. 

Zaccheus Collins. 

Peter S. Duponceau, LL. Do 

Charles Chauncey. 

Joseph Hopkinson, LL. D. 

Joseph Ingersoll. 

Rev. Philip F. Mayer, D. D. 

Philip H. Nicklin. 

Rt. Rev. Henry U. Onderdonk, D. D. 

John C. Lowber. 

Robert Walsh, Jr. LL. D. 

Rev. Thomas H. Skinner, D. D. 

Joseph Reed, Secretary. 



Professors in the Collegiate Department. 

Rev. WILLIAM H. DE LANCEY, D. D., Provost and Professor of Moral Phi- 

losophy. 
ROBERT ADRAIN, LL. D. Vice-Provost and Professor of Mathematics. 
Rev. SAMUEL B. WYLIE, D. D. Professor of Languages. 
ALEXANDER DALLAS BACHE, Esq., Professor of Natural Philosophy and 

Chemistry. 
Rev. EDWARD RUTLEDGE, A. M. Assistant Professor of Moral Philosophy. 



268 QUARTERLY PERISCOPE. 

Professors in the Medical Department. 

PHILIP SYNG PHYSICK, M. D. Professor of Anatomy. 

NATHANIEL CHAPMAN, M. D. Professor of the Institutes and Practice of 

Physic and Clinical Medicine. 
WILLIAM GIBSON, M. D. Professor of Surgery. 

JOHN REDMAN COXE, M. D. Professor of Materia Medica and Pharmacy. 
ROBERT HARE, M. D. Professor of Chemistry. 
THOMAS C. JAMES, M. D. Professor of Midwifery. 
WILLIAM E. HORNER, M. D. Adj. Professor of Anatomy. 
WILLIAM P. DEWEES, M. D. Adj. Professor of Midwifery. 
SAMUEL JACKSON, M. D. Assistant to the Professor of the Institutes and 

Practice of Physic and of Clinical Medicine. 

Wiliiam E. Hobneb, Bean. 

Andrew Jackson, President, John C. Calhoun, Vice-President, John Mar- 
shall, Chief Justice, of the United States. 

John Andrew Shulze, Governor, John B. Gibson, Chief Justice, of the Com- 
monwealth of Pennsylvania. 

George M. Dallas, Mayor of the City of Philadelphia. 

This inscription, deposited March the twenty-first, A. D. one thousand eight 
hundred and twenty-nine, commemorates the laying of the corner-stone of the 
New Medical Hall, fifty-four years after the original organization of the Medical 
Faculty by Drs. Morgan and Shippen. The institution having in the mean time 
conferred the Degree of Doctor of Medicine upon upwards of two thousand Gen- 
tlemen educated within its walls, who, dispersed in different quarters of the 
United States, have thus extended the blessings of sound Medical Instruction, 
and in many instances organizing themselves into New Schools of Medicine, 
have thus made the University of Pennsylvania the Parent of Medical Science 
in Che United States. 

Architect, William Strickland. Stone-cutter, John Struthers. Bricklayer, 
Daniel Groves. Carpenter, John O'Neil. 



TRANSYLVANIA UNIVERSITY. 

Trustees. 

John Wesley Hunt, Esq. Chairman. William Richardson, Esq. 

John Bradford, Esq. John Brand, Esq. 

Thomas Bodley Esq. Rev. Ryland T. Dillard, 

Dr. Elisha Warfield, ; Hon. Thomas M. Hickey, 

Benjamin Gratz, A. M. Rev. Nathan H. Hall, 

Thomas Nelson, Esq. Henry Collyers Payne, Esq. 

Richard Henry Chinn, Esq. Robert S. Todd, Esq. 

Joseph Logan, Esq. Rev. Spencer Cooper. 

Faculty. 

ALVA WOODS, D. D. President and Professor of Moral and Intellectual Philo- 
sophy. 

BENJAMIN WINSLOW DUDLEY, M. D. Professor of Anatomy and Surgery. 

CHARLES CALDWELL, M. D. Professor of the Institutes and Clinical Prac- 
tice. 

JOHN ESTEN COOKE, M. D. Professor of the Theoiy and Practice of Me- 
dicine. 

WILLIAM HALL RICHARDSON, M. D. Professor of Obstetrics and Diseases 
of Women and Children. 



American Intelligence. 



269 



CHARLES WILKINS SHORT, M. D. Professor of Materia Medica and Medical 

Botany, and Dean of the Faculty. 
JAMES BLYTHE, D. D. Professor of Chemistry. 
CHARLES SHAW, M. D. Librarian of the Medical Faculty. 



GRADUATES. 

At a public commencement held in the Chapel of the University, on Tuesday, the 
10th of March, 1829, the degree of Doctor of Medicine was conferred on the fol- 
lowing gentlemen, alumni of the School, who had undergone satisfactory exa- 
minations before the Medical Faculty, Trustees, and President, and written 
Theses on subjects annexed to their names. 



Kentucky. 
Robert S. Apperson, 
John Charlton Beatty, 
Richard W. Ferguson, 
Charles Hay, . . . 
Henry Hopson, . . 
John Terrel Lewis, 
Preston Lindsay, 
Thomas J. Moore, . 
Alexander H. Peck, 
James Ritchie, . . 
Thomas Stevenson, 
Robert J. Waggener, 
Henry F. Washington, 
Walter Carr Winter, . 

Mississippi. 
Charles Walton Harris, 
Charles Shaw, . . . 
Solomon Tracy, . . . 
William W. Usher, . . 
William Kinne Wilson, 
Ellis Pusey Passmore, . 

Alabama. 
William Kelsay Adams, 



Richard Tucker Harper, 
Jacob Chancy Jordan, . 
Sidney Smith Prince, . 

William W. Wilson, . 

Tennessee. 
Erasmus D. Fenner, 
James M'Kinney Gray, 
JohnM'Call, .... 
Henry H. Treadway, . 
South Carolina. 
Archibald I. Barron, 
Thomas Latta Dunlap, 
Gilbert Tennent, . . 



Franklin Williams, . 
Virginia. 
William Bomar, . . 
Peter Leath Penn, . 



Subject of Thesis. 
Sarcocele. 

Paracyesis Abortus. 

Physiology and Pathology of the Teeth. 
Anatomy and Physiology of the Stomach. 
Menstruation. 
Milk Sickness. 

Identity of summer, fall, and winter epidemics. 
Erysipelas. 
Phthisis Pulmonalis. 
Hydrocele. 

Syphilitic and Pseudo-syphilitic affections. 
Functions of the large Intestines. 
Dyspepsia. 
Ophthalmia Purulenta. 

Lacteal and Venous Absorption. 

Nature and Treatment of Syphilis. 

Uterine Haemorrhage. 

Malignant, Congestive, Bilious Fever. 

Dropsy. 

Uterine Haemorrhage. 

Medical Topography and Endemic Fever of Lime- 
stone county, Alabama. 

Analogy between the Liver and the Brain. 

Operation of Lithotomy. 

Medical Topography and Endemic Fever of Franklin 
county, Alabama. 

Sleep. 

Uterine Haemorrhage of Pregnancy. 

Opium. 

Purgative Medicines. 

Syphilis. 

Syphilis. 

Hernia of the Abdominal Rings. 

Medical Topography of Abbeville District, S. C. with 

Observations on Bilious Fever, as it occurred there 

in the summer of 1828. 
Diet. 

Hydrocele. 
Curved Spine. 



270 QUARTERLY PERISCOPE. 

Louisiana. 
Owen Connelly Blount, . Teeth. 
William Henry Lyne, . . Bilious Fever. 
Michigan - . 

Rice M'Coy, Actual Cautery. 

Josephus M'Coy, . . . Pathology and Medical Treatment of Calculus Af- 
fections. 
Ohio. 
Rezin Thompson, . . . Digestion. 

Total, 40. C. W. SHORT, M. D. Dean. 



MEDICAL COLLEGE OF SOUTH CAROLINA. 

At a commencement held in Charleston, on Wednesday, March 23d, 1829, the 
prize of a gold medal was presented to Edwin D. Faust, M. D. for the best 
English thesis. An address was delivered by Thomas Y. Simons, and the 
degree of M. D. was conferred on the following gentlemen: — 

William N. Askew, of South Carolina, on the Melia azedarach in Infantile Re- 
mittent Fever. 

Ed. H. Bond, of Georgia, on Dysentery. 

Bryan Beddingfield, of Georgia, on Cynanche Trachealis. 

J. P. Baird, of Florida, on Acute Hepatitis. 

C. F. Butler, of South Carolina, on the Circulation of the Blood. 

Elias S. Bennett, of Charleston, on the Chenopodium anthelminticum. 

William M. Brailsford, of Charleston, on the Circulation of the Blood. 

Carnot Bellinger, of S. C. on Hernia. 

G. P. Cohen, of Charleston, on Intermittent fever. 

C. C. Capers, of St. Helena, on the Gelseminurum Semper Virenes. 

Isaac T. Coutrerier, of Pineville, on Worms. 

Samuel D. Carter, of Sumpterville, on Acute Hepatitis. 

Albert T. Dozier, of Abbeville, on the functions and sympathies of the Liver. 

Henry Dockery, of Richmond, N. C. on the Endemic of Richmond County, N. C. 

Gibbes Elliott, of Charleston, on the Dengue or Erupto Rheumatic Fever. 

Geo. P. Frierson, of Charleston, Bilious Remittent Fever. 

Edwin Faust, of Columbia, on the Chemical, Anatomical, Physiological, and 
Pathological relations of Fibrin. 

J. E. B. Finley, of Charleston, on Mania a Potu. 

Alex. Gadsden, of Charleston, on the Mutual Influence of the Mind and Body on 
each other. 

Arthur Gibbes, of Charleston, on Inguinal Hernia. 

E. P. Gibert, of Abbeville, Bilious Remittent Fever. 

Wm. D. Gourdin, of Charleston, Sanguine Depletion. 

Robert Harllee, of Marion, Cynanche Trachealis. 

Larkin G. Jones, of N. C. Peculiarities of the Female. 

E. H. Kelly, of Charleston, Empresma Hepatitis. 

Noah Lyons, of Chester, Hepatitis. 

Thos. Lilly, of N. C. on Mercury. 

A. M ( Laren, of Abbeville, Acute Hepatitis. 

E. C. Mortimer, of Charleston, Lues Venerea. 

Thos. Moore, of Chester, Mania. 

Holmes Mathews, of Edisto, Hydrocele. 

Edward North, of Charleston, Dropsy. 

Isaac Nichols, of Charleston, Hydrothorax. 

Joel Pearson, of Fairfield, Acetate of Lead. 

John F. Poppenheim, of Charleston, on Inflammation. 

Robert J. Turnbull, of Charleston, Typhus Icterodes. 

Josiah S. Wilson, of Geo. Ascites. 



American Intelligence, 271 



John A. Walton, of N. C. Functions of the Spleen, 
C. Young, of Union, on the Asclepias Syriaca. 
Total, 39. 



COLUMBIAN COLLEGE, District of Columbia. 

At a Medical Commencement of the Columbian College, in the District of Co- 
lumbia, held March 11th, 1829, in the City of Washington, the degree of 
Doctor in Medicine was conferred on the following gentlemen: — 

J. Irwin Dunn, of Washington city, on Vermes. 
J. B. Elliot, of Washington city, on Mania a Potu. 
J. M. Higgins, of Maryland, on Cholera Infantum. 
Gonsalvo Hodges, of Maryland, on Enteritis. 
J. L. M< Williams, of Maryland, on Haemoptysis. 
Benjamin F. JYourse, of Washington city, on Variola. 
J. M. Stewart, of Maryland, on Hydrocephalus. 
A. M. Stanford, of England, on Dysmenorrhea. 
Timothy Upham, of New Hampshire, on Typhus Fever. 
Total, 9. 

The Professors of the Medical Department of the Columbian College, in the 
District of Columbia, anxious to extend the benefits of regular Medical educa- 
tion to Students whose pecuniary means will not enable them to attend courses 
of public lectures, have adopted the following resolutions: — 

Resolved, That this school be open to the admission of one student of the 
character contemplated in the foregoing preamble, from each of the United 
States, and one from each of the territories, to attend all the lectures, without 
charge. 

Resolved, That the senators of congress are hereby authorized to select one 
such student from their respective states, and the delegates of congress one 
such student from their respective territories, who shall be admitted to gratui- 
tous attendance on the lectures, by exhibiting a certificate of selection from the 
senators or delegate, to the dean of this department. It is to be understood that 
said student shall pay five dollars on entering the school, as a matriculating fee, 
and should he graduate in this institution, a fee of twenty dollars will be re- 
quired. 

JAMES M. STAUGHTON, M. D. Dean. 
Washington City, Jan. 24, 1829. 



PHILADELPHIA MEDICAL SOCIETY. 

Officers for 1829. 

President.— Philip Syng Phtsick, M. D. 

Vice Presidents. — Joseph Parrish, M. D. Samuel Jackson, M. D. 
Corresponding Secretaries. — John Bell, M. D. Benjamin H. Coates, M. D. 
Orator. — Benjamin H. Coates, M. D. 

Curators. — Alfred Drake, M. D. Thomas H. Ritchie, M. D. 
Treasurer. — D. Francis Condie, M. D. 
Librarian. — Alfred Drake, M. D. 

Library Committee. — Hugh L. Hodge, M. D. Charles D. Meigs, M. D. Robert 
M. Huston, M. D. 

The following lectures were read before the Society during the winter session. 
Dr. Condie. On Peritonitis, as occurring in Young Children. 



272 QUARTERLY PERISCOPE. 

Dr. Bell. On the origin of the Periodical Fevers of Rome and its vicinity. 
Communicated by Professor Giacomo Folcht, of Rome. 

Dr. R. Coates. On the connexion of certain Mechanical and Hydrostatic Phe- 
nomena with Physiology and Surgical Practice. 

Dr. Darrach. On the Reciprocal Circulation of the Blood between the Mother 
and Foetus, and the use of the Placenta. 

Dr. Rousseau. On the management of Labour during Parturition. 

Dr. Barnes. On Conception. 

Dr. Hodge. A Communication from Professor Quadri, of Naples, on Acu- 
puncturation. 

Dr. Jackson. On the difference of action between General and Topical De- 
pletion. 

Dr. Bell. On Medical Creeds. 

Dr. Hodge. On Erysipelas. 

Dr. Horner. On the Pathology of the Nervous System. 

Dr. Meigs. Remarks on some of Broussais' Propositions in Medicine. 

Dr. Harris. On Asphyxia. 

Dr. Beattie. On the Use and Abuse of the Forceps in Obstetrical Practice. 

Dr. Rousseau. On Hydrophobia. 

Dr. Condie. On Haematemesis. 

The following gentlemen were elected honorary members of the Society. 

Dr. Sacco, of Milan^ Professor Giacomo Folchi, of Rome; Professor Quadri, 
of Naples; Professor Mojon, of Genoa; Dr. ChaufFard, of Avignon; Professor 
J. D. Cams, of Liepsic; Dr. A. N. Gendrin of Paris; Dr. Bournonville, of Phi- 
ladelphia. 

The following gentlemen were admitted as junior members. 

Pennsylvania. — Robert H. Jones; J. F. Bullock; Joseph Baldwin; William 
N. Johnson; John Perdui; Samuel Abernethy; Obed Bailey; J. Meckley; Simon 
A. Wicks; Elijah Griffiths; George W. Norris; James M'Clintock; John R. Tag- 
gart; Dr. Erasmus Thomas. 

New Jersey. — Dr. John R. Sickler; William P. Garrison; Charles Sartori. 

Maryland. — Lyttleton M. Robertson. 

Virginia. — J. N. Powell; Singleton J. Cooke; William Pettit. 

Ohio. — Gustavus Allen; Edson B. Olds; Edward Thompson; Joab Wright. 

South Carolina. — William G. Adams. 

Louisiana. — F. N. Ogden; Dr. Edward Chew; Augustus H. Cenas. 

Trinidad de Cuba. — Joseph M. Urquiola. 

From the Records of the Society, 

ROBERT M. DUNBAR, 
Recording Secretary. 



PHILADELPHIA VACCINE INSTITUTION, 

Established in the year 1822, with the approbation of Professors Phtsick, 
Chapman, James, Gibson, and Coxe, Doctors Hartshorne, Hewson, Monges, 
&c. &c. 

The subscribers to the above Institution, those practitioners who have for the 
last eleven years obtained their supplies of vaccine virus from the undersigned, 
and the profession generally throughout the United States, are respectfully in- 
formed, that applications for vaccine virus will be attended to as usual, at all 
seasons of the year, and at one day's notice, by the undersigned, 

JOSEPH G. NANCREDE, M. D. 
S. E. corner of Tenth and Walnut streets, Philadelphia. 



THE 



AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES, 



No. VIII.— August, 1829. 35 



COLLABORATORS, 



Jacob Bigelow, M. D. Professor of 
Materia Medica in Harvard Univer- 
sity, Boston. 

Walter Changing, M. D. Professor of 
Midwifery and Legal Medicine in 
Harvard University, Boston. 

N. Chapman-, M. D. Professor of the 
Institutes and Practice of Physic and 
Clinical Practice in the University of 
Pennsylvania. 

John Redman Coxe, M. D. Professor 
of Materia Medica and Pharmacy in 
the University of Pennsylvania. 

William C. Daniell, M. D. of Savan- 
nah, Georgia. 

J. B. Davidge, M. D. Professor of 
Anatomy in tlie University of Mary- 
land. 

E. De Butts, M. D. Professor of CJie- 
mistry in the University of Mary- 
land. 

William P. Dewees, M. D. Adjunct 
Professor of Midwifery in the Univer- 
sity of Pennsylvania. 

S. Henry Dickson, M. D. Professor of 
the Institutes and Practice of Medicine 
in the Medical College of South Caro- 
lina. 

Benjamin W. Dudley, M. D. Profes- 
sor of Anatomy and Surgery in Tran- 
sylvania University. 

Gouverneur Emerson, M. D. of Phila- 
delphia. 

Thomas Fearn, M. D. of Alabama. 

John W. Francis, M. P. Professor of 
Obstetrics and Forensic Medicine in 
Rutgers Medical College, New York. 

William Gibson, M. D. Professor of 
Surgery in the University of Pennsyl- 
vania. 

John D. Godman, M. D. late Prof essor of 
Anatomy and Physiobgy in Rutgers 
Medical College, New York. 

R. E. Griffith, M. D. of Philadelphia. 

E. Hale, M. D. of Boston. 

Robert Hare, M. D. Professor of Che- 
mistry in the University of Pennsyl- 
vania. 

Isaac Hays, M. D. one of the Surgeons 
of the Pennsylvania hifirmary for 
diseases of the Eye and Ear. 

George Hay ward, M. D. of Boston, 



Thomas Henderson, M. D. Professor 
of the Theory and Practice of Medi- 
cine in the Columbian College, Dis- 
trict of Columbia. 

William E. Horner, M. D. Adjunct 
Professor of Anatomy in the Univer- 
sity of Pennsylvania. 

David Hosack, M. D. Professor of the 
Institutes and Practice of Medicine in 
Rutgers Medical College, New York. 

Ansel W. Ives, M. D. of New York. 

Samuel Jackson, M. D. Assistant to tlie 
Professor of the Institutes and Practice 
of Medicine and Clinical Practice in 
the University of Pennsylvania. 

Samuel Jackson, M. D. of Northum- 
berland, Pennsylvania. 

W. J. Macneven, M. D. Professor of 
Therapeutics and Materia, Medica in 
Rutgers Medical College, New York. 

C. B. Matthews, M. D. of Philadelphia. 

Valentine Mott, M. D. Professor of 
Surgery in Rutgers Medical College, 
New York. 

James Moultrie, Jr. M. D. of Charles- 
ton, S. C. 

Reuben D. Mussey, M. D. Professor 
of Anatomy and Surgery in Dart- 
mouth College. 

James M. Pendleton, M. D. Lecturer 
on Midwifery and Diseases of Women 
and Children, New York. 

Philip Syng Physick, M. D. Profes- 
sor of Anatomy in the University of 
Pennsylvania. 

Nathaniel Potter, M. D. Professor of 
the Theory and Practice of Medicine 
in the University of Maryland. 

Thomas Sewall, M. D. Professor of 
Anatomy and Physiology in the Co- 
lumbian College, District of Columbia. 

John Ware, M. D. of Boston. 

John C. Warren, M. D. Professor of 
Anatomy and Surgery in Harvard 
University, Boston. 

J. Webster, M. D. Lecturer on Ana- 
tomy and Surgery, Philadelphia. 

N. W. Wouthington, M. D. Professor 
of Materia Medica intJte Columbian 
College, District of Columbia. 

Thomas H. Wright, M. D. Physician to 
the Baltimore Aims-House Infirmary. 



TO READERS AND CORRESPONDENTS. 



Communications have been received from Professors Mussey and Horned, 
and from Drs. Mighels, of Cumberland County, Maine; Jackson, of Northum- 
berland County, Pennsylvania; and Henderson, of Huntingdon County, Penn- 
sylvania. 

Dr, Randolph's case of excision of the lower jaw, will appear in our next, 
with a plate. 

We have received the following' works: — 

Traite" General d'Anatomie Comparee. Par J. F. Meckel, traduit de PA1- 
lemandet augments de notes, par MM. Riester et Aim. Sanson, D. M. P. Tome 
troisieme. Ire Partie. Paris, 1829, (from the publishers.) 

Cours de Physiologic Gendrale ct Comparee Profcsse a la Faculte" des Sci- 
ences de Paris. Par M. Ducrotay de Blainville, Membre de l'Institut. Public 
par les soins de M. le Docteur Hollaiid, et revue par l'auteur. Livraison Ire 
et 2°, (from the publishers. ) 

Napoleon a Sainte-Helene. Opinion d'un Me"decin sur la Maladic de PEmpc- 
reur Napoleon et sur la Cause de sa Mort; offerte a son fils au jour de sa majo- 
rity. Par J. Hereau, ancien Chirurgien ordinaire de Madame Mere, et premier 
chirurgien de l'lmperatrice Marie-Louise. Paris, 1829, (from the author.) 

Journal des Progres des Sciences et Institutions M£dicales en Europe en 
Amerique, &c. Vol. XIII, (in exchange.) 

Annales de la M6decine Physiologique, October, 1828, and January, Feb- 
ruary, March, 1829, (in exchange.) 

Revue M£dicale, November, 1828, (in exchange.) 

Bulletin des Sciences Medicales, October, 1828, (in exchange.) 

Journal Universel, November, 1828, January, February, March, April, 1829, 
(in exchange.) 

Journal General de Medecine, December, 1828, January, February, March;, 
April, 1829, (in exchange.) 

Nouvelle Bibliotheque Medicale, January, February, 1829, (in exchange.) 

Archives Generates de Medecine, February, March, April, 1829, (in exchange.) 

Journal der Chirurgie und Augen Heilkunde, herausgegeben von C. F. V. 
Graefe und Pn. V. Waltheii. Band. XII. Stiich 1, 2, 3, (in exchange.) 



276 TO READERS AND CORRESPONDENTS. 

Litterarische Annalen dcr Gesammten Heilkunde. Herausgegeben von Dr. 
J. F. C. Hecker. December, 1828, and January, February, 1829, (in exchange.) 

Gemeinsame deutsche Zeitschrift fiir Geburtskunde. Herausgegeben durch 
D. W. H. Buscn, L. Mende, und F. A. Ritgen. Band III. Heft 3, und Band 
IV. Heft 1, (in exchange.) 

Notizen aus dem Gebiete der Natur und Heilkunde gesammelt und mitge- 
theilt. Von Ludwig, Fr. von Fhoriep, August to December, 1828, and Janu- 
ary to March, 1829. 

The Medico-Chirurgical Review, for April, 1829, (in exchange.) 

The London Medical and Surgical Journal, April, May, June, 1829, (in ex- 
change.) 

The London Medical and Physical Journal, March, April, May, June, 1829, 
(in exchange.) 

The London Medical Gazette, March, April, May, 1829, (in exchange.) 

Boston Medical and Surgical Journal, Vol. II. Nos. 10 to 21, inclusive, (in 
exchange.) 

The Transylvania Journal of Medicine, and the Associate Sciences, May, 
1829, (in exchange.) 

The North American Medical and Surgical Journal, July, 1829, (in exchange.) 

The New York Medical and Physical Journal, April, 1829, (in exchange.) 

For the gratification of our contributors we continue the references to the 
works, in which they will find notices of their communications; these references 
are, of course, restricted to the Journals received during the preceding three 
months. 

Professor Physick's Case of Cough from Elongation of the Uvula is noticed 
in the London Medical and Physical Journal, for June, 1829. 

Professor Chapman's paper on Emetics in Haemorrhage is copied into the 
London Medical and Surgical Journal, for April, 1829. 

Professor Mott's Case of Calcareous Degeneration of the Scrotum is noticed 
in the Archives Generates, for February, 1829; and his Case of Excision of an 
Osteo-Sarcomatous Clavicle in the Medico-Chirurgical Review, for April, 1829, 
the London Medical Gazette, for February, 1829, and Froriep's Notizen, for 
December, 1828. 

Professor Dewees's paper on Ergot is noticed in the Archives Generates, for 
May, 1829. 

Professor Gibson's Case of Axillary Aneurism is noticed in the London Me- 
dical and Physical Journal, for April, 1829, and Froriep's Notizen, for Dec. 
1828. 

Dr. Jackson's Case of Amnesia is copied into the London Medical and Sur- 
gical Journal, for June, 1829. 









TO READERS AND CORRESPONDENTS. 277 

Dr. Stedman's Case of Bleeding in the Radial Artery in a case of Apoplexy- 
is noticed in the Annaire Medico-Chirurgical, for 1827. 

Dr. Mitchell's Experiments on the Corpora Lutea are noticed in the Ar- 
chives Generates, for February, 1829. 

Dr. Penstock's Experiments on the Effect of Cupping-glasses in Poisoned 
Wounds are noticed in the Archives Generales, for February, 1829. 

Dr. Mauban's Case of Malformation of the Heart is noticed in the Archives 
Gene"rales, for February, 1829. 

Dr. Drake's Experiments on the Respiration of Cool air in Pulmonary Dis- 
eases are analyzed in the Medico-Chirurgical Review, for April, 1829, and Fro- 
riep's Notizen, for January, 1829. 

Dr. Heiskele's Case of Extra-Uterine Fcetation is copied into the Nouvelle 
Bibliotheque M£dicale, for January, 1829. 

Dr. Levebt's Experiments on Metallic Ligatures are noticed in the Boston 
Medical and Surgical Journal, for June, 1829. 

Dr. Washington's Case of Gunshot Wound is copied into Froriep's Notizen, 
for August, 1828. 

Authors of new medical books, desirous of having them reviewed or noticed 
in this Journal at the earliest opportunity, are invited to transmit to the Editors 
a copy as soon after publication as convenient, when they will receive prompt 
attention. Under ordinary circumstances, very considerable delay is caused 
by the circuitous routes through which they are received. 

Papers intended for publication, should be sent, free of expense, as early after 
the appearance of the Journal as possible, in order to be in time for the en- 
suing number. Such communications should be addressed to "Cabey, Lea 
& Cabet, Philadelphia, for the Editors of the American Journal of the Medical 
Sciences." All letters on the business of the Journal to be addressed exclu- 
sively to the publishers. 



No. VIII— August, 1829. 36 



CONTENTS, 



ORIGINAL COMMUNICATIONS. 

ESSAYS. 

Abt. Page. 

I. On the Means of affording Respiration to Children in Reversed Presenta- 
tions. By Jacob Bigelow, M. D. Professor of Materia Medica in Harvard 
University _._-_ 285 

II. Notice of an Epidemic that prevailed in Savannah, Georgia, during the 
Summers of 1826 and 1828. By W. C. Daniell, M. D. of Savannah, 
Georgia 291 

III. Case of Acute Gastritis, supervening upon Chronic, arising from In- 
temperance, and attended with Arachnitis of the Cerebrum. By W. E. 
Horner, M. D. Adjunct Professor of Anatomy in the University of Penn- 
sylvania. [With a plate.] 294 

IV. Observations on Entropion, with a Case. By Samuel Jackson, M. D. 

of Northumberland 297 

V. On the Internal Use of the Spirit of Turpentine in Incarcerated Hernia. 
By Thomas Sewall, M. D. Professor of Anatomy and Physiology in the 
Columbian College, District of Columbia - 301 

VI. Account of the Small-pox Epidemic in Western Pennsylvania. By L. 
Callaghan, Licentiate of the Faculty of Physicians and Surgeons, and 
Member of the Faculty of Medicine of Glasgow . - - 302 

VII. Perforation of the Stomach, without Ulceration or Softening of its 
Coats. By Leonard Peirce, M. D. of Sutton, Massachusetts - - 305 

VIII. Some Observations on Wounds of the Heart. By John Redman 
Coxe, M. D. Professor of Materia Medica and Pharmacy in the University 

of Pennsylvania ---------- 307 

IX. Inquiry into the Causes, Nature, and Treatment of Hernia Cerebri. 

By J. W. Heustis, M. D. of Cahawba, Alabama - 315 

X. Method of treating Fracture of the Thigh Bone. By William C. Daniell, 

M. D. of Savannah, Georgia. [With a plate.] 330 

XI. Remarkable Urinary Calculus. By R. D. Mussey, M. D. Professor of 
Anatomy and Surgery in the Medical Institution at Dartmouth College, 
Hanover, N. H. [With a plate.] 333 

XII. Reports of Cases treated in the Baltimore Alms-house Infirmary. By 
Thomas H. Wright, M. D. Physician to the Institution - 337 

XIII. Cases of Cynanche Trachealis. By Samuel Jackson, M„ D. Assistant 
to the Professor of the Institutes and Practice of Medicine and Clinical 
Practice in the University of Pennsylvania - 361 



280 CONTENTS, 

XIV. Meteorological Observations made in the City of Philadelphia, lati- 
tude 39° 57' , and on the Island of Tinicum, eleven miles south-west from 
Philadelphia, latitude 39° 48' for the year 1826. By George F. Lehman, 

M. D. Lazaretto Physician of the Port of Philadelphia - - - 370 

MEDICAL LITERATURE. 

XV. Memoir of the Life and Writings of the late Colin Chisholm, M. D., 
F. R. S. &c. &c. formerly Inspector General of Ordnance Hospitals in 
the West Indies ----- 394 

REVIEW. 

XVI. Recherches Anatomiques, Pathologiques et Th£rapeutiques sur la 
Maladie connue sous les noms de Gastro-enterite, Fievre Putride, Ady- 
namique, Ataxique, Typhoid, etc. etc. Compared avec les Maladies 
Aigues les plus Ordinaires. Par P. Ch. A. Louis, Docteur en Medicine 
des Facult£s de Paris et de St. Petersbourg, Membre de PAcademie 
Royale de M^decine, Correspondant de l'Acad£mie Imperiale Medico- 
Chirurgicale de St. Petersbourg, de celle de Marseille, chef de Clinique 
de la Faculte de M£decine de Paris, etc. etc. Two vols. oct. pp. 989. 
Paris, 1829 - 4-03 

BIBLIOGRAPHICAL NOTICES. 

XVII. Encyclopadisches Worterbuch der medicinischen Wissenchaften. 
Herausgegeben von der Professoren der medicinischen Facultat zu Ber- 
lin; C. F. von Grafe, C. W. Hufeland, H. F. Link, K. A. Rudolphi, E. 
von Siebold. Erster band. 8vo. pp. 675. Berlin, 1828 - - - 443 

XVIII. Pathological Researches into the Nature and Treatment of Dropsy 
of the Brain, Chest, Abdomen, Ovarium, and Skin; in which are demon- 
strated the Inflammatory Origin of these Diseases, and the General Fa- 
cility of their Cure under a new and greatly Improved Method of Treat- 
ment. By Joseph Ayre, M. D. Member of the Royal College of Physi- 
cians, &c. London, 8vo. pp. 287 444 

XIX. Napoldon a Sainte-Helene. Opinion d'un M£decin sur la Maladie de 
l'Empereur Napoleon et sur la Cause de sa Mort, offerte a son fils au 
jour de sa majorite*. Par J. H£reau, Ancien Chirurgien ordinaire de Ma- 
dame Mere et Premier Chirurgien de lTmpe"ratrice Marie-Louise. Paris, 
1829, pp. 228, 8vo 448 

XX. Recherches Anatomiques et Physiologiques sur les cas d'uterus 
double et de Superfoetation. Par A. L. Cassan. Paris, 1826, pp. 84. 452 

XXI. Illustrations of the Diseases of the Breast, (Female.) By Sir Astley 
Cooper, Bart., F. R. S., Sergeant Surgeon to his Majesty, &c. &c. In 
two parts. Part 1st, pages 89, quarto. Plates IX. London, 1829 - 453 

XXII. Journal of the Philadelphia College of Pharmacy. Edited by Benja- 
min Ellis, M. D. Professor of Materia Medica and Pharmacy in the Col- 
lege, &c. Assisted by a publishing committee, consisting of D. B. Smith, 
C. Ellis, S. P. Griffitts, Jr. and G. B. Wood, M. D. Professor of Chemis- 
try in the College, Stc. Published by the College. Philadelphia, 1829, 
Nos. land 2 454 






CONTENTS. 



281 



XXIII. Elements of Medical Statistics, containing the substance of the Gul- 
stonian Lectures, delivered at the Royal College of Physicians. With 
numerous additions, illustrative of the comparative salubrity, longevity, 
mortality, and prevalence of diseases in the principal countries and cities 
of the civilized world. By F. Bisset Hawkins, M. D. of Exeter College, 
Oxford; Fellow of the Royal College of Physicians, and Physician to the 
Westminster General Dispensary. London, 1829, pp. 234. 8vo. - 458 

XXIV. Observations on the Nature and Treatment of Cholera, and on the 
Pathology of the Mucous Membranes. By Alexander Turnbull Christie, 
M. D. Madras Medical Establishment, and lately in Medical Charge of 
the Civil Department in the Southern Mahratta Country. Edinburgh, 
1828, pp. 137. 8vo. 463 

XXV. Journal des Progre's des Sciences et Institutions M£dicales en Eu- 
rope, en Amenque, &c. Tome XII. Paris, 1828 - - - 472 



QUARTERLY PERISCOPE. 

FOREIGN INTELLIGENCE. 

Anatomy. 



Page. 

1. Absence of the Thymus Gland. 

By Dr. Harrington - - 473 

2. Zonula Zinnii in the Human 
Eye. By Professor M. J. Weber ib. 



Page. 
3. Anterior Termination of the 
Retina. By Dr. Schneider - 474 



Physiology. 



4. On the supposed Existence of 
Active Molecules in Mineral 
Substances. By Robert Bake- 
well, Esq. ... - 474 

5. Case of Five Children at a Birth, 
furnished by Dr. Weiss, and 
communicated to the Clinic by 

M. Cams - 476 

6. Case of a child born with a Tu- 
mour of considerable size upon 
the Occiput, with Parencepha- 
locele. By M. Brouissaux, (Le- 
ger,) M. D. - - - ib. 

7. Superfoetation in a Double Ute- 
rus. By Dr. Duges - . 477 

8. Destruction of the Right He- 
misphere of the Brain, with He- 



miplegia of the left side, the In- 
tellect unimpaired - - 477 

9. Case of Anaesthesia or loss of 
Sensation, unattended with cor- 
responding loss of Motion. By 
Alexander Reid, Esq. 

10. On the Physiological Effects 
of Oxygen Gas upon the Animal 
System. By S. D. Broughton, 
Esq. 

11. Silver found in the Viscera of 
a Person who had used the Ni- 
trate of Silver. By Dr. Wede- 
meyer - - - - 

12. Functions of the Intestinal Ca- 
nal and Liver in the Human Foe- 
tus. By Dr. Lee 



ib. 



479 



ib. 



480 



Pathology. 



13. Case of Colica Pictonum. By 
Edward Barcome, Esq. With re- 
marks by Staff-Surgeon Doyle 480 

14. Rare Species of Dysphagia. By 

Dr. Mugna - - - 483 



15. Dropsy of the Pericardium. 

By F. W. Wood, Esq. - 484 

16. Inflammation of the Umbilical 
Vein with Infantile Erysipelas. 

By Robert Lee, M. D. - ib. 



282 



CONTENTS. 



Page. 

17. Perforation of the Stomach, 
with Peritoneal Inflammation, 
where no Symptoms indicative 
of previous Disease existed. By 
John Abercrombie, M. D. - 485 

18. Ulcer of the Stomach fatal by 
Hemorrhage. By John Aber- 
crombie, M. D. - - - 486 

19. Ulceration of the Stomach fa- 
tal by Perforation. By John 
Abercrombie, M. D. - - ib. 

20. Perforating- Ulcer of the Sto- 
mach, and communication with 
the Arch of the Colon. By John 
Abercrombie, M. D. - - 487 



Page. 

21. Involuntary Periodical Drun- 
kenness. By M. Pierquin - 487 

22. Case of extraordinary Univer- 
sal Emphysema. By Dr. Jahn. 488 

23. Case of Coma which lasted 
Fifteen Months. By Dr. Bischoff 489 

24. Rupture of the Heart. By Dr. 
Bignardi - 490 

25. Disease of the Heart - 491 

26. Satyriasis. By M. Chauffard ib. 

27. Hernia of the Lungs from 
Tight Stays. By M. Breschet ib. 

28. Cynanche Tonsillaris. By Dr. 
Watson ---. 492 



Materia Medica. 



29. Mode of Exhibition of Copai- 
ba 492 

30. Anti-asthmatic Effects of the 
Tincture of Lobelia Inflata. By 
Mr. W. B. Andrews - - ib. 



31. New Mode of using Iodine. 

By M. Pelletan 492 

32. Rhubarb Plant - - ib. 



Practice of Medicine. 



33. Case of Pneumathorax in 
which an operation was unsuc- 
cessfully performed. By James 
Johnson, M. D. - - - 493 

34. Case of Pneumathorax in 
which an Operation was success- 
fully performed. By John Davy, 

M. D. .... 495 

35. Case in which two ounces of 
Sulphuric Acid was Swallowed. 

By J. Orr, Esq. - - ib. 

36. On the Treatment of Inter- 
. mittent Fevers by the Sulphate 

of Quinine, applied to a denud- 
ed Surface of the Skin. By Pro- 
fessor C. Speranza - - 496 

37. Remarkable Case of Abdomi- 
nal Dropsy. By Dr. Bardsley 497 

38. Ergot of Rye in Chronic Ute- 
rine Discharges. By Dr. Mar- 
shall Hall ... - ib. 

39. On the Utility of Cold Affusion 
in Cases of Poisoning by Hydro- 



cyanic Acid. By Dr. E. F. G. 
Herbst .... 497 

40. Vapour of Iodine for the cure 
of Consumption. By Dr. Ber- 
ton - 498 

41. Treatment of Burns by the 
Application of Flour. By J. 
Marshall, Esq. - ib. 

42. Observations on the Blood. 

By Dr. Davy - ib. 

43. On Chlorine in Hydrophobia. 
By Drs. Semmola and Schoen- 
berg 500 

44. Angina Tonsillaris, Variolous 
Angina, and ffidema of the Glot- 
tis, cured by Insufflation of fine- 
ly powdered Alum. By A. La- 
ennec - ib. 

45. Gonorrhoea - ib. 

46. On Small Doses of Oil of Tur- 
pentine for the cure of Sciatica 
and other Neuralgia. By M. 
Martinet, M. D. - - - ib. 



Ophthalmology. 



47. On Complete Inversion of the 
Eyelids. By Mr. Stratford - 501 

48. Cataract completely formed 
in a few hours. By Dr. Wendel- 
strom ... 502 



49. Ossification of the Vitreous Hu- 
mour. By M. Kuhn - - 502 

50. On the Operation for Cataract. 

By Dr. Zeuschner - - 503 



CONTENTS. 



283 



Surgery. 



Page. 

51. Compound Fracture of the 
Olecranon. By H. Earle, Esq. 504 

52. Sinuses in the Region of the 
Pelvis. By James Syme, Esq. 505 

53. Case in which the operation 
of Lithotritie was successfully 
performed. By Robert Liston, 
Esq 506 

54. (Edema of the Glottis relieved 
by Tracheotomy. By M. Cho- 
mel 507 

55. Case of Hernia, in which a 
Fold of Intestine was contained 
in a Sac between the Abdomi- 



Page. 
nal Muscles and the Peritoneum. 
By Henry Earle, Esq. - 507 

56. On the Reduction of Hernia. 

By M. Dupuytren - - 509 

57. On Secondary Hemorrhage. 

By Mr. Hodgson - - 510 

58. Ununited Fracture of the Fe- 
mur, successfully treated by the 
Seton. By Dr. Dohldorf - ib. 

59. Extirpation of a Cancerous Tu- 
mour situated in the Interior of 
the Rectum : Cure. By M. Maurin 511 

60. Treatment of Elephantiasis. 

By M. Lisfranc - ib. 



Midwifery. 



61. Case of Expulsion of the 
Placenta, three months after 
Abortion. By Mr. Thornton 511 

62. Delivery of a Foetus through 



the Abdominal Parietes. By Dr. 
Miiller 512 

63. Six successive Hip Presenta- 
tions in the same Individual ib. 

64. Hip Presentations - - 513 



Medical Jurisprudence. 



65. Case of Poisoning with Nux 
Vomica. By Dr. Basedow - 

66. Case of Poisoning with Nux 
Vomica. By Mr. Baynham - 

67. Case of Suicidal and Infantici- 
dal Mania - 

68. Injury from Sulphuric Acid. 
By Robert Christison, M. D. 

69. Chemical Analysis of various 
Articles of Dress, in order to as- 



513 



ib. 



514 



515 



certain the nature of Fluid pour- 
ed upon them. By Drs. Christi- 
son and Turner - - - 516 

70. Alleged attempt to effect 
Abortion - 517 

71. Two Cases in which the Ex- 
ternal Application of Corrosive 
Sublimate proved fatal. By John 
Ward, Esq. 520 



Chemistry. 



72. On Supposed Artificial Dia- 
monds. By M. Thenard - 521 

73. Preparation of Hydriodic Acid ib. 

74. Preparation of Iodine. By M. 
Souberan - ib. 



75. On Phosphoric Acid in Pot- 
ash. By M. Kobell - - 522 

76. On Nitrate of Silver as a test 

for Animal Matter. By Dr. Davy ib, 



Miscellaneous. 



77. Yellow Fever 522 

78. On Small-Pox, By Dr. George 
Gregory .... 526 

79. Report of the Council of 
Health of the City of Paris for 
the year 1827 - - - 528 



80. On Feigned Diseases of the 
Heart. By Dr. Quarrier - 529 

81. On Phrenology. By Dr. El- 
liotson - ib. 



284 



CONTENTS. 



AMERICAN INTELLIGENCE. 



Page. 

Mercury detected in Swaim's Pa- 
nacea by Chemical Analysis. 
By R. Hare, M. D. Professor of 
Chemistry in the University of 
Pennsylvania. (Communicated 
in a letter to Dr. Hays) - 530 

Congenital Hydrocephalus, form- 
ing- a Cyst on the Back of the 
Head, containing the Posterior 
Lobes of the Cerebrum: Water 
evacuated by Puncture of the 
Brain. By W. E. Horner, M. D. 
Adjunct Professor of Anatomy 
in the University of Pennsylva- 
nia ib. 

A Case of Prolapsus Uteri. By Sa- 
muel B. Toby, M. D. of Provi- 
dence, R. I. (Communicated in 
a letter to William M. Fahnes- 
tock, M.D.) 532 

On Muriate of Lime in Paralysis of 
the Lower Extremities. By 
Alexander Somervail, M. D. of 
Essex County, Virginia - ib. 

A Case of Glossitis, attended with 
alarming symptoms of Suffoca- 
tion, successfully removed by 
deep incisions made into the 
substance of the Tongue. Com- 
municated by A. Hopton, M. D. 
of Clinton, North Carolina 533 

The Operation of Laryngotomy 
and Tracheotomy performed at 
the same time, and on the same 
subject for the removal of an 
extraneous body from the La- 
rynx. By Abner Hopton, M. D. 534 

Of the Precipitation of Morphia 



Page. 
from Laudanum by Ammonia; 
also of a Spontaneous Deposi- 
tion of Narcotin. Ry R. Hare, 
M. D. Professor of Chemistry in 
the University of Pennsylvania 535 

Dissection of a Case of Peritoneal 
Dropsy. Communicated by John 
D. Godman, M. D. - - ib. 

Extirpation of Cancer of the Ute- 
rus. By J. P. Warren, M. D. 
Professor of Anatomy and Sur- 
gery, Harvard University - 536 

Operation for Artificial Urethra. 
By Dr. Warren - - - 537 

Case of Paralysis from Fracture, 
in which a part of the Spinous 
Processes of two Vertebrae, half 
of the third, and the whole of 
the fourth, were removed by an 
operation, with partial success. 
By Alb an G. Smith, M. D. of 
Danville, Kentucky - - ib. 

Anatomico-Surgical Drawings and 
Descriptions of all Surgical Ope- 
rations, according to the most 
approved methods. ByL. J. von 
Bierkowsky - ib. 

Addresses by J. D. Godman M. D. 538 

A Treatise on Pathological Ana- 
tomy. By W. E. Horner, M. D. 
Adjunct Professor of Anatomy 
in the University of Pennsylvania ib. 

Edwards's and Vavasseur's Mate- 
ria Medica and Pharmacy; trans- 
lated by J. Togno, M. D. & E. 
Durand ... - ib. 

Necrology - ib. 

Index - - - - 541 



PL,. 1H, Vol. 4 










1M 



■& 



ir^. 



Drawn fivm nature. ICEna'd In/ JJfrautm. 



JPlate 4 Vol A , 
Fa. S3 2 






JEng'cl In/ XBvaiiton 



THE 

AMERICAN JOURNAL 



OF THE 



MEDICAL SCIENCES.- 



Art. I. On the Means of affording Respiration to Children in Re- 
versed Presentations. By Jacob Bigelow, M. D. Professor of 
Materia Medica in Harvard University. 

IT is familiar to obstetric practitioners, and is noticed by most 
writers on midwifery, that in those cases of labour in which the body 
of the child is delivered before the head, a considerable degree of 
danger exists in regard to the life of the child. Rules for the con- 
duct of such cases are laid down by writers, yet it cannot be denied 
that, in the hands even of skilful practitioners, many children which 
are alive when the body is expelled, are irrecoverably lost before the 
head can be extracted. In these cases death takes place because the 
connexion with the mother is interrupted, by compression of the cord, 
or detachment of the placenta, before a communication with the at- 
mosphere is effected. 

It is the object of the present paper to show, that in many such 
cases the life of the child may be saved, by forming a communication 
between the mouth and the atmosphere, previous to the delivery of 
the head. 

After the body is expelled, if the head can be seasonably deliver- 
ed, either by the recurrence of pains, or by the successful efforts of 
the practitioner, no difficulty ordinarily occurs. But this desirable 
state of things cannot always be realized. Too frequently the size 
of the head, and the resistance of the pelvis or soft parts, renders 
the delivery difficult and hazardous, and the practitioner in the midst 
of his efforts, is apprised by a convulsive jerk or spring of the body, 
that a state of extreme danger exists, and that the time has come at 
which the child must breathe or will speedily die. If at this period 
the fingers be introduced, so as to reach the mouth of the child, it 

No. VIII — August, 1829. 37 



286 Bigelow on Respiration in Reversed Presentations. 

will be perceived that each jerk of the body is attended with a gasp, 
and convulsive effort at inspiration, performed by the mouth and chest 
of the child. In this state of things, if air be conveyed to the mouth 
of the child it will immediately breathe, and the efforts of nature, as 
will hereafter be shown, may in most cases be safely waited for to 
assist in expelling the head. 

The method to be pursued in conveying air to the mouth, depends 
upon the situation of the head. If the chin has descended low in the 
pelvis, so that the mouth rests upon the perinaeum or lower part of 
the sacrum, and can be readily reached by the fingers, the hand of 
the operator alone is sufficient to give the assistance required. But 
if the mouth is situated so high in the pelvis as to be reached with 
difficulty, or if, from the large relative size of the head, there is much 
compression, the assistance of a tube may be of use. The mode of 
proceeding which I have found successful in various instances is as 
follows: as soon as the body and arms are extracted, supposing the 
face towards the sacrum, an assistant supports the body, carrying it 
towards the pubis ; or the reverse, should the position of the face be 
to the pubis. The accoucheur should then introduce the hand to 
which the face looks, till the middle fingers rest upon the mouth of 
the child. The hand is then to be raised from the throat of the child, 
making the ends of the fingers a fulcrum, and pushing the peringeum 
backwards. The air will thus pass upwards as far as the chin of the 
child. The middle fingers are now to be separated about half an 
inch from each other, and thus a complete passage will be formed be- 
tween them, by which the air will reach the mouth of the child. If 
the child be in a healthy state up to this period, it will immediately 
breathe and cry, and the delivery of the head may be safely postponed 
until the natural pains recur. If, from any degree of asphyxia, the 
child does not immediately breathe, it may often be made to do so 
by dashing cold water upon the body, or by other stimulating pro- 
cesses. It has even appeared to me practicable to inflate the lungs, 
in some cases, through an elastic catheter. When the mouth is so 
high in the pelvis as to be reached with difficulty, or when the com- 
pression is so great as to obliterate the cavity between the fingers, a 
flat tube will be found useful, made of metal, of spiral wire covered 
with leather, or of elastic gum, and having its largest diameter about 
half an inch. If the tube be of metal, or of any incompressible ma- 
terial, it should be withdrawn during a pain, to prevent contusion of 
the soft parts, and immediately replaced, if the pain subsides without 
expelling the head. Such a tube may be considered as a prolongation 
of the trachea, and is fully sufficient to sustain life by respiration for 



Bigelow on Respiration in Reversed Presentations. 287 

a considerable time. The tube must be guarded and directed by 
keeping it between the fingers of the inserted hand. 

The following are a part of the cases which have occurred to me 
in practice, affording an opportunity for the trial of this method. 

Case I. — A patient was in labour with her second child, August 8th, 
1824. The case was one of breech presentation, and without any un- 
usual occurrence the body and arms were delivered in about three 
hours after my arrival. The position of the head was of the most com- 
mon kind, with the vertex above the pubis, and the face in the lower 
part of the hollow of the sacrum. At this time my left hand was pass- 
ed upward, with a view of depressing the chin, but the child being 
large, it required some effort to reach the mouth with the fingers. 
The time consumed in doing this was too great for the safety of the 
child, and the convulsive spring of the body took place. I was forci- 
bly struck at the same moment by perceiving a gasp of the mouth at 
the ends of my fingers, and the idea occurred that if a communication 
could be made to the atmosphere, the child would respire. Attempts 
were made without success to extract the head by a moderate force, 
aided by the efforts of the mother and by pressure made by an assistant 
over the fundus of the womb. At the same time the hand which rest- 
ed over the mouth and throat was raised a little, and the fingers open- 
ed to give passage to the air. The child soon gave another convulsive 
spring, and at the same moment inspired. The hand being retained 
in the same position, a slow, but constant respiration continued, ac- 
companied with a low, moaning cry, for eight or ten minutes, when the 
recurrence of a pain caused the head to be delivered. During the 
whole of this period before the final pain, the mouth was several inches 
within the perineeum. 

Case II. — This case occurred May 1st, 1826, and was also a 
breech case. Being a first labour, it was protracted for eighteen hours. 
After the presentation was ascertained, I had made, in a hasty man- 
ner, a tube about five inches long and half an inch wide, slightly 
flattened, and slightly bent over at its extremity. The case being 
one of more than common interest, I provided myself likewise with 
forceps. Although the mother had been in perfect health, yet the 
body of the child when expelled, was found emaciated and dark co- 
loured, exhibiting marks of feeble life. As much force as it was 
thought justifiable to use, was employed to extract the head, with no 
other effect than to bring the mouth within about two inches of the 
edge of the perinseum. The tube was now introduced and placed in 
the mouth of the child, but it did not respire. It will be observed 
that the child had exhibited no convulsive effort, nor any signs of 



288 Bigelow on Respiration in Reversed Presentations. 

being alive. An attempt was now made to inflate the lungs, which 
failed, apparently from want of tightness in the tube, the joining not 
having been soldered. It nevertheless appeared to me practicable 
to have inflated the lungs in this situation, with a suitable tube, since 
the tightness with which the perinaeum covers the face would assist 
in preventing regurgitation of the air. The foregoing attempts having 
proved unavailing, the forceps were introduced, with the aid of which 
the head was extracted. The child was resuscitated with great diffi- 
culty, and did not breathe spontaneously, until artificial respiration 
had been kept up, by inflating the lungs through a quill, for more 
than half an hour. It was two hours before the respiration became 
so perfect that the child could be left to itself. I have no doubt that 
this child would have respired before the birth of the head, had there 
been sufficient constitutional vigour to produce the effort. 

Case III. March 29th, 1827. — This patient had had five children. 
In her sixth labour the presenting part was found to be the arm. The 
pelvis being large, and the parts dilatable, no difficulty occurred at 
the proper time in introducing the hand, rupturing the membranes, 
and finding the feet, which were brought down and the body deliver- 
ed. The face turned towards the perinaeum, the mouth was easily 
reached, and the fingers were opened to give passage to the air as be- 
fore described. No struggle nor attempt at inspiration, however, oc- 
curred. A handful of cold water was then dashed upon the body, 
upon which the child immediately gave a spring and began to cry. 
The head was not delivered until some minutes afterwards. 

Case IV. — In a case of twins, January 29th, 1829, the first child 
presented the nates, and was born with the face to the sacrum. After 
the delivery of the body, the fingers were passed up to the mouth of 
the child, and opened to give passage to the air. As in former cases 
the child began to cry in a low voice, with slow respiration, the 
mouth being two or three inches within the perinaeum. Feeling se- 
cure in regard to the life of the child, I determined in this instance, 
to use no extractive effort, but to wait for the expulsive action of the 
uterus. In the mean time I called the attention of the females who 
were present, to the crying of the child, which continued without in- 
terruption, though the head and neck were buried in the pelvis. In 
a few minutes an expulsive pain threw out the head with very little 
assistance on my part. The presentation of the second twin was 
natural. 

Case V. — This occurred in the same patient as Case III. In this 
labour the presenting parts were the breech and left hand. After the 
birth of the body the face was found so strongly pressed against the 



Bigelow on Respiration in Reversed Presentations. 289 

sacrum, as to render it difficult to form a passage for the air. By a 
gentle extractive force, the head was made to descend lower in the 
pelvis, and a tube was placed in the mouth. The child in this situ- 
ation respired, and after a few minutes, with the assistance of a pain, 
the head was easily extracted. 

The foregoing practice is not new, though it appears to have been 
lost sight of by most of the later writers on midwifery. I am not 
aware that it is mentioned by Smellie, Denman, Hamilton, Burns, 
or Dewees. Merriman alludes to it as a thing which is possible, 
but does not speak experimentally on the subject. In one of the 
older writers, however, a practice nearly similar is described, and 
warmly recommended from the author's experience. In Pugh's 
Treatise of Midwifery, published in 1754, are the following instruc- 
tions:— 

"The arms being" brought down, the head only remains to be extracted, 
which must be done with as much expedition as possible, as indeed the arms 
ought to be; for when the child has passed the navel, the circulation between 
it and the mother is stopped, from the pressure of the umbilical rope. You 
must then introduce the fingers of your left hand into the vagina, under the 
child's breast, and put the first and second fingers into the child's mouth pretty 
far, so far however, that you are able to press down the child's tongue in such 
a manner that by keeping your hand hollow, and pressing it upon the mother's 
rectum, the air may have access to the larynx, you will soon perceive the tho- 
rax expand, as the air gets into the lungs. Many authors make very little trou- 
ble in extracting 1 the head, but without a well formed pelvis, every operator 
must know there is difficulty and great danger of losing" the child by its stay in 
the passage; but by this method of giving the child air, I have saved great num- 
bers of childrens lives, which otherwise must have died." 

"Before I made use of this method, and pressing" externally to assist in ex- 
tracting the head, I found many children were lost in this situation for want of 
air, which put me upon inventions; as likewise a third, which was a curved flat- 
tish pipe, as likewise a flexible one, that I introduced into the child's mouth as 
near to the larynx as I could, the other end external, which I found answer, 
but now as I find my fingers generally answer, I seldom make use of it." Page 
49-50. 

The foregoing practice of Pugh is virtually the same to which I had 
resorted before meeting with his book. That part of his directions, 
which relates to introducing the fingers into the child's mouth, and 
pressing down the tongue, appears superfluous; for if the air is car- 
ried as far as the child's lips, it will enter the lungs whenever the 
child makes a natural effort to inspire, and without this effort, the 
practice will be unavailing. 

I am aware that it is a prevailing opinion, sanctioned by the au- 
thority of respectable writers, that when the face is upon the lower 



290 Bigelow on Respiration in Reversed Presentations. 

part of the sacrum or upon the perinaeum, the head is wholly in the 
vagina, and that therefore no farther aid is to be expected from the 
efforts of the uterus in promoting its expulsion. This I take to be an 
erroneous view of the subject. After the body is expelled from the 
womb, its remaining contents are the head and the placenta. These 
constitute a collective mass, upon which the uterus may continue to 
act, as long as either of them is contained in its cavity. The head, 
therefore, whether partly in the uterus, or wholly in the vagina, is 
subject to be acted upon through the placenta, and I have little 
doubt, that in all common cases, it would sooner or later be expelled 
by the uterine efforts alone. Of the fact that expulsive pains acting 
upon the head, do occur in these cases, my own experience does 
not permit a moment's doubt. The same fact I have also found to be 
confirmed by the observations of several of my medical brethren. 
And I think every accoucheur of experience must have remarked, 
that there are times, when the safe extraction of the head, by exter- 
nal force, is difficult and even impracticable, while at others, under 
similar circumstances of size and position, it is perfectly easy, owing 
doubtless to the co-operative efforts of the womb. 

That the extraction of the head by external force alone, acting 
through the neck, is not always an easy, or a safe operation, we may 
conclude from the cautious manner with which writers speak upon 
the subject, and from the known fact, that many children die after 
the body is delivered. It is true that multitudes of successful cases 
occur, and it is these chiefly which are published, while those of the 
opposite kind are consigned to oblivion. It appears probable, that the 
successful cases are those, in which a favourable proportion exists 
between the head and pelvis, or in which the efforts of the operator 
are seconded by uterine pains. 

The course of proceeding which appears to me most likely to pre- 
serve the life of the child in these cases, is as follows. As soon as 
the body is delivered, the patient being on her back, the body of the 
child is to be supported by the right hand of the operator, or by an 
assistant, while the fingers of the left hand are introduced to search 
for the mouth. A passage for the air to the mouth is to be formed by 
raising the perinseum from the face, and opening the fingers in the 
manner already described. If the child inspires, it may be consider- 
ed safe, and while the respiration continues, no other care is neces- 
sary than to support the body in a favourable position, and to keep 
the passage unobstructed till the pains return. In the meantime, the 
patient may be encouraged to exert herself at intervals, in voluntary 
efforts, and at the same time, an assistant should press and rub with 



Daniell on Dengue. 291 

some force upon the fundus of the womb, with a view to excite con- 
traction. * When any expulsive effort occurs, it is to be seconded by 
the practitioner by extracting, and the head will in general be deli- 
vered without violence or danger. 

When it happens that the child does not spring, and makes no ef- 
fort to breathe after air is conveyed to the mouth, attempts should be 
made to resuscitate it by dashing a handful of cold water on the body, 
and by rubbing the back and lower extremities, and striking them 
with the hand. This will be likely to excite inspiration, and the rest 
of the case may be conducted as before: or an elastic tube may be 
placed in the mouth or nostril, and an attempt made to inflate the 
lungs, the perinseum in the meantime being pressed closely to the 
face. But in general, if the child does not respire soon after the air 
is conveyed to it, it is owing either to a defect of constitutional vi- 
gour or excitability, or to the unfavourable circumstances of the labour, 
and in this case no time should be lost in extracting the head, by the 
neck, or by the forceps, according to the rules laid down for these 
cases by obstetrical writers. 



Art. II. Notice of an Epidemic that prevailed in Savannah, Georgia.) 
during the Summers of 1826 and 1828. By W. C. Daniell, 
M. D. of Savannah, Georgia. 

IN the month of August, 1826, a fever made its appearance in Sa- 
vannah, from which very few escaped. I am inclined to the belief, 
that this was the same disease with the Dengue, which prevailed so 
extensively the last season, in Charleston, this place, and elsewhere. 
It is certainly true that the same consequences did not follow the 
former, that attended upon the latter. This, however, may, I think, 
be accounted for, without violating the presumption that the two dis- 
eases are identically the same. The severity of the pains which at- 
tended upon the fever of 1826, induced the sufferers, who believed 
the danger proportioned to the degree of suffering they endured, to 
invoke the early aid of the profession; and the symptoms prompted 
the physicians to an energetic treatment. 
The revulsive and tonic treatment of fever, which has been adopt- 

* Pressing and rubbing upon the fundus of the womb has always appeared to 
me one of the most powerful means of exciting the contraction of that organ in 
cases of flooding, and of retained placenta, 



292 Daniell on Dengue. 

ed amongst us, was well adapted. to the cure of the prevailing epide- 
mic of 1826. The eruptions were brought out and fixed upon the sur- 
face early in the disease, by the use of mustard plasters. The admi- 
nistration of serpentaria, (Virg.) and bark or quinine, kept up a 
moisture upon the surface, and gave tone to the system. Hence no 
unpleasant consequence followed the disease. 

Before the reappearance of this fever in the summer of 1828, when 
it bore the name of Dengue, our people, by public report, had been 
taught to view it as a new disease, with which physicians were not ac- 
quainted, and when attacked with it, for the most part, merely re- 
sorted to some palliative for a pressing symptom. The physicians, 
generally disposed to associate a new remedy with a new name of 
disease, treated their patients without system, and consequently 
without success. 

My own observation sustains me fully in the remark, that the 
Dengue of 1828, was as manageable as the Break-bone fever, (as it 
was called,) of 1826, in which latter not a death is recollected to 
have occurred. 

It is not my intention to detail the symptoms of the Dengue, as 
they have repeatedly been described. In the fifth number of this 
Journal will be found an article upon this disease, containing an ac- 
count of the symptoms, by Dr. Dickson, of Charleston. It is true 
that the writer does not discriminate between the symptoms that cha- 
racterized the disease, and those that were the result of injudicious 
treatment. If my own views of the Dengue be correct, and if I am 
successful in giving an exposition of them, the judicious reader will 
readily perceive what symptoms were appropriate to the disease, and 
what were superinduced by the absence of all remedies, or their in- 
judicious application. 

The Dengue is certainly an exanthematic fever. At an early pe- 
riod, an eruption invariably appears in some part of the body, un- 
less prevented by active purging, bleeding, or some other injudicious 
prescription. Upon fixing and maintaining this eruption on the sur- 
face, and allowing it gradually to pass off by perspiration, depends 
the radical cure of the disease. 

As just stated, my great object in treating Dengue was to fix the 
disease upon the surface. To this end, upon visiting a patient labour- 
ing under it, and especially in the first stages of the disease, I direct- 
ed a mustard plaster to be placed on the abdomen to inflame the skin.* 
If the eruption had previously existed, this increased it, or in its ab- 

* See my treatise on Autumnal Fevers, pp. 103, 4, and 5, 



Daniell on Dengue. 293 



*o 



sence produced it. In some cases additional plasters of the same ar- 
ticle were placed on the extremities. Whenever the eruptions were 
fully established on the surface, the pains of the different parts of 
the frame were removed. 

If circumstances indicated their use, castor oil, or some mild lax- 
ative was given, to obviate or remove costiveness. 

The eruptions having been fixed on the surface, serpentaria, and 
bark or quinine were given, until the fever subsided, which was com- 
monly from two to four and five days. After that, the serpentaria was 
given alone for six or eight days, by which a constant and gentle 
moisture was maintained on the surface. During this latter period, 
animal food, porter, or wine, were given the patient in small quanti- 
ties. Under the above briefly recited treatment, the eruptions gradu- 
ally passed off, (usually before the fever, ) and the patient was re- 
stored to health, without being subjected to the usual consequences 
of the disease, as pains in the limbs, swellings and stiffness of the 
joints, which appeared to run on for months, and afterwards might 
be renewed by any slight exposure. 

When the skin has been inflamed, the eruptions increase, and in 
many instances run into each other, producing the appearance of a 
deep blush over the whole face, neck, and breast. When a moisture 
has been produced to some extent, there is an abatement in the deep 
colour of the eruption. This eruption, as before remarked, gradually 
subsides. In the communication of Dr. Dickson above referred ;to, 
he observes, that "the patient was liable to a second, third, and in- 
deed indefinite number of returns of the disease, or relapses, as 
they were called, while such as were properly covered with the erup- 
tion about the sixth day, were protected from any future attack. To 
this rule there was no exception in my practice, as I may confidently 
assert after particular attention to the matter." pp. 11-12. 

Where the eruption has been regarded as an accidental symptom, 
and allowed to disappear, or where it has been repelled or prevented 
from appearing, by the use of purges, the lancet, antimonials, &c. 
almost every part of the system is liable to be attacked- Several 
cases of mania, consequent upon repelled eruptions, occurred within 
my observation. Dr. Foskman informed me of another, in his own 
practice. In a lady it produced an inability to retain her urine. The 
most singular consequence which I witnessed, however, as resulting 
from repelled eruptions, was a case of general tetanus, which termi- 
nated fatally. 

I am anxious to impress fully on the mind of the reader, the 
great importance of keeping up a gentle perspiration for six or eight 

No. VIII.— August, 1829. 38 



294 Horner's Case of Gastritis. 

days after the disappearance of all the symptoms of the disease, by 
the use of an infusion of serpentaria. Upon patients who refused to 
submit to this additional treatment, the pain, &c. have returned, and 
in many instances have produced much suffering and even lameness. 

The acute stage of Dengue is, in its effects upon the system of the 
patient, of but little importance when compared with the chronic 
stage — or to speak more correctly, the stage consequent upon the re- 
pelled eruptions. How long this latter may continue, it is impossible 
yet to say, as some are still suffering from injudiciously treated or 
neglected cases of Dengue, which occurred the last summer. 

I have derived but little satisfaction, from any method which I have 
been enabled to devise for the treatment of chronic Dengue. Some 
relief has been afforded, and it is believed a few cases were cured, 
by bathing the affected members in cold water saturated with salt, 
and afterwards using frictions with a flesh-brush or coarse napkin, 
until perspiration was produced. It was necessary to continue this 
treatment for eight or ten days. In other instances, however, it has 
wholly failed. 

Savannah, May, 1829. 



Art. III. Case of Acute Gastritis, supervening upon Chronic, arising 
from Intemperance, and attended with Arachnitis of the Cerebrum. 
By W. E. Horner, M. D. Adjunct Professor of Anatomy in the 
University of Pennsylvania. [With a plate.] 

\X ILLIAM C. aged forty-three, innkeeper, has used alcoholic 
drinks in excess for the last eight or ten years, and become much en- 
feebled from them. The last summer he had a severe dysentery 
which lasted several weeks. 

Nov. Q2d, 1827.— I visited him for the first time. 

Habitude. — Not much emaciated, skin pallid and temperate. 

Countenance. — Dull and unmeaning. 

Intellectual Functions. — Disposed to taciturnity, and dull in appre- 
hension. 

Sensitive Apparatus. — Hearing dull. 

'Respiration and Circulation.— Natural. 

Locomotive Apparatus. — Very much enfeebled, scarcely able to 
walk. 

Digestive Apparatus. — No appetite. 



Horner's Case of Gastritis. 295 

He did not complain of pain in any particular part. Ordered vale- 
rian tea. 

November 2,5th. — I visited him again, and found him labouring 
under hallucinations, of which he was sensible; for he observed that 
though the figures were before his eyes, yet he knew they were decep- 
tive. He complained also of pain in the epigastrium, and suffered 
from a retention of urine. The muscles of the abdomen were rigid, 
and drawn towards the spine. He had spent several nights without 
sleeping. Ordered opium two grains, and camphor one grain, to be 
made into a pill, and repeated every three hours till sleep be pro- 
cured. Four of these pills produced the desired effect, and he slept 
soundly the following night. 

The next day forty leeches were applied to the epigastrium with 
much advantage in diminishing the pain there, and two days after- 
wards a blister was put upon the same region. 

December 1st. — His speech became suspended; great tenderness 
occurred in the abdomen, and the most excruciating pain in the lower 
extremities upon their being moved. His tongue became covered 
with a thick yellow coat, and his strength exceedingly prostrated. 
Volatile alkali was administered in a julep to the amount of five 
grains every two hours. He took several doses of it, and the next 
day I found that the moisture of the tongue had disappeared, and the 
yellow coat had dried up into a dark brown one. In the further 
progress of his treatment up to the day of his death, a mild cathartic 
was administered on three or four occasions, also a decoction of ser- 
pentaria and bark at intervals. His nourishment was wine whey, 
arrow root, and such light articles as he could be induced to swallow. 

It was attempted twice to leech him on the head, but the leeches 
refused to bite; he was then cupped on the temples. He was also 
cupped along the spine, half a dozen cups on each side; and had 
mustard poultices applied to his ankles. He sunk gradually, and died 
this morning, December 7th, at four o'clock. From the day on which the 
retention of urine first occurred till the day of his death, the bladder 
continued paralytic, and an extremely foetid, dark urine was daily 
brought off by the catheter. Also, for several days before death, he 
was incapable of moving the lower extremities, notwithstanding their 
extreme sensibility to the touch. 

Autopsy. Twelve hours after death. 

Head. — Very strong adhesion of dura mater to bone. In attempt- 
ing to remove the latter, several drachms of serum were lost, which 
"were supposed to come from beneath the tunica arachnoidea. The 
latter was turbid, and raised in vesications. 

Blood-vessels of pia ifHater very turgid, as also those in the cerebrum; 



296 Horner's Case of Gastritis. 

the latter on being cut into, bled freely, and much serum exuded from 
it. Cerebellum soft; adhesion between thalami unusually strong; a 
cluster of transparent vesicles on each side of plexus choroides ; blood- 
vessels of velum very turgid. Spinal marrow, veins on surface very 
turgid; very great vascular fulness internally, giving a red pink 
colour along the roots of the anterior fasciculi of nerves where they 
came from within the medulla spinalis. Spinal marrow not so vascu- 
lar along the roots of posterior fasciculi, but still having a supera- 
bundance of blood. 

Thorax. — Ancient universal pleuritic adhesion on both sides; lungs 
healthy; heart healthy, its blood not coagulated. 

Abdomen. — No peritoneal disease. 

Stomach universally inflamed, and within of a deep pink colour, not 
coming from extravasation as in fever, but from the immense number 
and the fulness of its veins, which ran along the surface of the inter- 
nal coat. At many places their capillaries were so numerous as to 
look at a little distance like small spots of extravasation, which, how- 
ever, with the aid of a microscope were found to be congeries of very 
fine vessels. Near the cardiac orifice there was a round patch, two 
or two and a half inches in diameter, consisting of thickly interwoven 
veins, containing black blood, and looking as if they were varicose; 
they were on the internal surface of the mucous membrane. In the 
pyloric region were two reddish slate-coloured patches, the indica- 
tions of a chronic irritation there, and about twenty-four lines in dia- 
meter. Pylorus thickened; stomach small; scarcely any gas in the 
bowels. 

Mucous coat of duodenum and jejunum inflamed to almost the 
same red colour with that of the stomach; ileum and colon of a bright 
pink colour internally; no ulceration of intestines; colon contained 
some well-elaborated faeces. 

Liver common size, degenerated into a drab colour, hard, dimi- 
nished vascularity; acini consisted in little hard scirrhus-like grains. 
The secretion of bile seemed to have been suspended, for the gall- 
bladder contained only a little black-coloured mucus. 

Pancreas healthy; spleen healthy; kidneys healthy. Mucous coat of 
bladder inflamed, being injected with a net-work of veins, large and 
small, which were particularly abundant about the neck. 

This patient had a mortification of the size of a dollar, from pres- 
sure on sacrum. On cutting into it,- as it was in the early stage, the 
blood was identified with the cellular substance and skin, so that it 
all looked like a bruise. 

Plate III. fig. 1. patch from the cardiac portion of the stomach; 
fig. 2. patch from the pyloric portion of the stomach. 



Jackson on Entropion. 297 

Art. IV. Observations on Entropion, with a Case. By Samuel 
Jackson, M. D. of Northumberland. 

1 HE various methods which have been practised for the cure of this 
troublesome affection are difficult or painful ; that of Saunders and 
Dorsey is followed by permanent deformity; and all of them are 
nearly impossible to perform on children. If the operation I have 
found successful in one instance, prove applicable to every tenth case, 
it will not be considered unworthy of public attention. 

One of my daughters, about three years old, was attacked with con- 
junctivitis, without any evident cause, in May, 1828; and as the dis- 
ease was mild it was too much neglected at the onset. About the 
1st of June she was sent to a dark room and confined there nearly ten 
months. During the first six of these months she had varicella, bi- 
lious fever, and frequent attacks of intermittent, all which fell upon 
her eyes, and aggravated the disease, so that by November the pal- 
pebrse were so much swollen that the eyes could not be seen, and the 
retina so sensible that she could not tolerate light sufficient to enable 
us to see any object, on first entering her apartment. In this state of 
things she found no comfort but in riding round the nursery in her 
wagon, with her face buried in a pillow. This indeed was her almost 
steady occupation, day after day, and from morning till night, for 
many months; nay, it was often necessary to rise in the night and 
give her this only comfort. 

She was so irritable and unmanageable that nothing could be stea- 
dily applied to the eyes with any advantage; nothing could be effect- 
ed with leeches, owing to the circumstance of her having been exces- 
sively alarmed with an attempt to apply some in the early stage of 
her complaint. It is not necessary to detail the particulars of the 
treatment, but a few of the more prominent facts I will detail. 

Blisters to the nucha and behind the ears were of no service during: 
any stage of the disease, and one at the insertion of the deltoid, three 
inches square, kept running profusely with savin Cerate for six weeks, 
was utterly useless; but when applied near the eyes, they never fail- 
ed to do good, and when drawn over the whole forehead at once, they 
sometimes reduced the photophobia so suddenly that she would cry 
out during the drawing of them, that it was too dark, she could not 
see. At length, by continual repetition of the blisters to her forehead 
and temples, not over the eyes, the swelling of the palpebrse gradu- 
ally lessened, and the intolerance of light also; she began to play 
about the dark room, and to amuse herself with a swing. 



298 Jackson on Entropion. 

In this state of things the disease assumed in some measure an in- 
termittent form. When running round the room with the greatest hila- 
rity, she would suddenly throw herself on the floor, with her face in 
her hands, and cry most piteously that her eyes hurt; her wagon was 
then demanded, and after riding three or four hours in sullen silence, 
her face buried in a pillow, a softness and moisture of the whole sur- 
face came on, when she would resume her cheerfulness and play about 
in the dark till bed-time. About the same hour on the following day, 
a similar scene was to be acted, though sometimes the paroxysms 
came on earlier, sometimes later, and not unfrequently they passed 
over one, two, or three days. We had reason to believe they were pre- 
ceded by a slight chill, they were certainly attended with an accelera- 
tion of the pulse, and they always went off with a softness of the skin. 
An attempt was made to cure them with quinine, but it failed en- 
tirely, and so did the prussiate of iron. Fowler's solution of arsenic 
was then tried in doses of five drops, four, five, and six times a day, 
and before she had taken it five days the paroxysms were checked, 
and the patient bore more light than she had done for eight months. 
This poison was then omitted, and the blisters were continued to her 
temples and forehead; the photophobia became every day less, till 
within three weeks from the time the arsenic was first used, she could 
bear as much light as would enable us to read large print with some 
difficulty. 

The paroxysms now returned precisely like the first, but the ar- 
senic or Fowler's solution removed them entirely and finally in four 
days; and by continual blistering, with gradually increasing the light, 
she was able, with the use of a green veil, to bear the full blaze of 
day by the first of April. One eye was now entirely well, but the 
other was found to be affected with entropion of the lower palpebra. 
The whole tarsus was turned under the eyeball, so as to present a 
smooth rounded contour, as represented in M. Demours' eighteenth 
plate. We made several attempts to pull down the lid and extricate 
the tarsus, but so violent was the action of the muscles that we ut- 
terly failed; therefore, as the eye was constantly improving we de- 
sisted from any further attempt, with the hope that the new cilia had 
not grown out so as to cause irritation. The swelling diminished 
every day under the use of blisters; the globe was not inflamed, but 
some matter filled the eye in the morning; every blister most evi- 
dently lessened the sensibility to light. 

Three weeks ago we made a very vigorous attempt, with Dr. 
Rodrigue's help, to pull out the tarsus, but succeeded only so far as 
to discover that the cilia had grown to nearly their full length and 



Jackson on Entropion. 299 

full number, and thairthe eyeball, rolling upon them, held the tarsus 
firmly under. Here was at once an end to all our dreams of a cure; 
for on such a restive child, now rendered infinitely impatient of every 
thing, we considered an operation as impracticable, and that the 
cilia would irritate the eye afresh, and prove a cause of insuperable 
inflammation. Wishing however to explore the state of things yet 
further, we made another violent attempt to pull out the tarsus, and 
fortunately the little sufferer did not resist, as she had always done 
before, with the utmost power of the orbicularis; so far from it, that, 
as it were by inspiration, she seized the palpebra with all her fingers, 
while mhffe were employed lower down, and she turned the tarsus 
completely out, so that the cilia spread over the front of the eye. It 
appeared to have no tendency to relapse; I saw it resume its natural 
situation and figure, nor could I compare the operation to any thing 
more appropriately, than to the reduction of a dislocated bone. The 
eye and palpebra assumed their natural appearance at once, and have 
ever since continued entirely well. The cilia stood erect at first, and 
spread over the eye, but they gradually assumed their proper direc- 
tion. 

This case was clearly not produced by ulceration, and consequent 
contraction of the inside of the palpebra; we should rather presume 
that the lid had been so distorted by tumefaction, that the tarsus was 
reverted under the eye-ball, and afterwards firmly held there by the 
pressure and rolling of the globe on the new cilia. This accords with 
the observations of M. Demours, that " the entropion of the inferior 
palpebra is most frequently the consequence of an oedema of its tis- 
sues, and particularly of a relaxation of that part of the skin which 
covers it."* 

When this case obtains he cured it by forcibly everting the tarsus and 
securing it from relapse, by drawing down the skin with strips of court 
plaster, " taffetas agglutinatif, vulgairement appele taffetas d'Angle- 
terre." By this method, which, however, he does not claim as origi- 
nal, he has cured the disease after four years continuance. But when 
this does not succeed, he recommends the following plan, which ori- 
ginated with himself. The patient is to place himself before a glass, 
draw out the tarsus, and resolutely hold it fast three days and as 
many nights, if the cure do not appear to be obtained sooner. He 
must not permit it to slip his fingers for a moment, as he will then 
lose all the fruit of his previous labour. He must sit all night be- 
fore his mirror, and if he should unfortunately give way to sleep, he 

* Tome premier, p. 105, De la Trichaise. 



300 Jackson on Entropion. 

is to seize the palpebra the moment he awakes. He relates the case 
of a lady, sixty years old, who had been afflicted with the disease 
fourteen years and yet cured herself by this method in two days and 
one night, having yielded to sleep only about two hours. M. De- 
mours very truly observes that the patient's success will depend on 
his vigour of mind and his desire of a cure. We cannot see why the 
hands of an assistant might not be substituted to relieve the patient, 
at least during the hours of sleep. 

My case was cured without any plasters, and without continuing 
the traction for one minute; is it not then very possible, that in some 
of M. Demours' cases, the cure might have been equally fftile, and 
that the continued traction and the plasters might have been entirely 
dispensed with ? However this may be, it is very certain, that one, 
or even all of these methods ought to be tried, before any cutting 
instrument is proposed, and particularly before the excision of the 
tarsus, an operation that must always leave a permanent deformity, 
which is very conspicuous in Mr. Saunders's second plate. 

The operation commonly ascribed to Scarpa, though it was prac- 
tised before his time, will not be followed by an equal deformity; but if 
we mistake not, it will never prove necessary in those cases which 
have been caused by mere relaxation and swelling of the palpebra. 
Our own cure consisted in reducing a mere dislocation, and the suc- 
cess depended principally on the child's having sunk the ends of her 
fingers deep into the space between the orbit and the eyeball, by 
which she pulled down the palpebra, and at the same time pushed 
the lower edge inwards, and thus dislodged and protruded the tar- ' 
sus. It showed not the least tendency to relapse, which might have 
been partly owing to the spreading of the cilia over the eyeball, until 
they gradually resumed their proper direction. 

I have been induced to offer this case and these observations, be- 
cause the most popular systematic authors in surgery, say nothing of 
Demours' practice, and would probably not suspect, that the simple 
operation, which relieved us in one minute of such gloomy anticipa- 
tions, could ever prove successful. 



Sewall on Turpentine in Incarcerated Hernia. 301 

Art. V. On the Internal Use of the Spirit of Turpentine in In- 
carcerated Hernia. By Thomas Sewall, M. D. Professor of Ana- 
tomy and Physiology in the Columbian College, District of Co- 
lumbia. 

hOME time since, I was informed by Dr. M 'Williams, a highly 
respectable physician of this city, that he had recently met with two 
cases of incarcerated hernia, in which the spirit of turpentine, exhi- 
bited in large doses internally, was successful in effecting a reduction 
of the protruded part, after all other means had failed. The circum- 
stances of these cases were such, as to inspire me with some confidence 
in the powers of the turpentine, and induce me to determine on its 
application as soon as an opportunity should present. It was not 
long after, that the following case of incarcerated scrotal hernia came 
under my charge. 

Early on Sunday morning I was called to visit a labouring man, 
by the name of Penn, a brick-maker by trade, a short, robust person, 
of about twenty-five years of age. He had enjoyed perfect health, 
with the exception of an entero-scrotal hernia, under which he had 
laboured for a number of years, and for which he had worn a truss. 

On my arrival I found that he had been in a state of great suffering 
during the night, and that he was still affected with intense pain and 
high fever. From inquiry I learned that while at work at his usual 
occupation, the day previous, the intestine escaped through the ab- 
dominal ring and descended into the scrotum, and that all the efforts 
which he could make to reduce it were ineffectual. On examining 
the scrotum, I found it greatly distended, hard, and tender to the 
touch. 

I first attempted a reduction of the bowel by taxis, but as my ex- 
ertions were unavailing, I bled him largely and then renewed my ex- 
ertions, but without success. I then gave him two ounces of the 
spirit of turpentine, and instructed my pupils, who remained with 
him, to repeat the same dose every hour, till eight ounces were taken, 
or some sensible effect produced. Soon after I left him, a profuse 
sweat took place, and he fell into a tranquil sleep. In about two 
hours the hernial tumour became soft and yielding and spontaneously 
retired from the scrotum. On repeating my visit in the middle of 
the day, I found he had taken about six ounces of the turpentine, and 
without experiencing any inconvenience from it. He was still sleep- 
ing, and entirely relieved. The next day he was at work in the 
brick-yard, and with no other complaint than that of a slight looseness 

No. VIII — August, 1829. 39 



302 Callaghan on Epidemic Small-Pox. 

of the bowels, and a scalding sensation in the rectum in passing his 
stools. No strangury was produced. 

Although it requires the experience derived from many cases to 
entitle a new remedy to confidence, the beneficial effects of the tur- 
pentine were so obvious and striking, in the above cases, that I have 
thought it proper to call the attention of the profession to its further 
trial. 



Art. VI. Jlccountof the Small-Pox Epidemic in Western Pennsylva- 
nia. By L. Callaghan, Licentiate of the Faculty of Physicians 
and Surgeons, and Member of the Faculty of Medicine of Glas- 
gow. 

V ARIOLA made its appearance in the city of Pittsburgh, in the 
month of October, 1828, and continued to May, 1829. It is said, 
the first case was that of a man of colour, reported to have come from 
Fort George. To this man a large proportion of our citizens are in- 
clined to attribute the misfortune of having been afflicted with this 
loathsome and severe visitation. This, however, is but taking a nar- 
row and unphilosophical view of the subject, and overlooking entirely 
the great exciting cause of epidemics in general, viz. their origin and 
propagation through the medium of atmospherical influence. It is 
supposed in the surrounding country, that the disease spread from 
this city as a centre; nothing can possibly be more remote from truth; 
it existed in many of the more remote counties nearly in as great a 
degree as in the city of Pittsburgh, in proportion to the number of 
subjects liable to the disease. 

Such was the dread inspired by the idea of its contagious influence, 
that persons arriving here from a distance, would scarcely delay a 
moment in the place; even those coming into town to attend market 
from the adjoining country, made all possible haste to get out again, 
under the impression that the disease could be caught no where but 
here. A goodly number of persons reported to have been vaccinated 
took the disease, insomuch that the faith of the community in the 
preventive powers of vaccination, is considerably shaken. One young 
man came under my observation, who had been vaccinated ten or 
twelve years before by a most respectable practitioner in Philadel- 
phia; he had a distinct and well-defined mark of a vaccine vesicle on 
the arm, yet he had the natural small-pox in the most regular manner, 
though mild. 



Callaghan on Epidemic Small- Pox. 303 

Here there were a numerous family of young persons, none of 
whom caught the disease. They had all been formerly vaccinated; 
some six, some nine, some twelve, and some twenty years before. A 
boy who had not been vaccinated, caught the disease; during his con- 
valescence, and throughout the greater part of his illness, a child, 
about three or four years of age, who had been formerly vaccinated, 
was much about him — she escaped the disease. 

In a family who occupied a house, in the cellar of which some per- 
sons of colour resided, ill of the small -pox, three of the children were 
liable to the contagion; they were vaccinated and escaped. 

It is customary with our people to suppose, that if, after the inser- 
tion of the vaccine virus, a vesicle appears, they are perfectly safe, 
so far as vaccination can protect them. Motives of ill-judged econo- 
my also induce many to vaccinate themselves; and even in many 
cases where the practitioner is called on to insert the vaccine matter, 
he has not an opportunity of judging whether or not it has taken proper 
effect. Hencethe occurrence of small-pox in very many of the instances 
which have taken place during this epidemic, after reputed vaccina- 
tion, argues nothing, so far as impairing our confidence in the pro- 
tective powers of this most valuable discovery is concerned. 

This epidemic was characterized in general by mildness of form, 
the eruption being of the distinct kind, and the fever of the inflam- 
matory type, exhibiting a readiness to give way to the usual reme- 
dial means. Some practitioners are of opinion that the disease showed 
itself in the confluent form in a few instances. I saw nothing of this. 
The eruption was occasionally so thick on the face as to give the ap- 
pearance of the vesicles running into each other; while on the body 
and extremities they were perfectly distinct, and the low typhoid 
form of fever was absent. The majority of the cases which terminat- 
ed fatally, were such as were either neglected or improperly treated 
during the eruptive fever, or had previously laboured under some con= 
stitutional defect entirely unconnected with the variolous infection. 

The disease was generally ushered in by a feeling of lassitude, 
pains over the extremities, giddiness and pain in the head, dry skin, 
furred tongue, restlessness, full and tense pulse, exacerbations of 
heat and cold, thirst, want of appetite, constipation of the bowels, 
throbbing of the temporal arteries, with frightful dreams. The sub- 
jects of attack were for the most part young persons, and principally 
children, although there were a few cases of persons of middle age. 

The mode of treatment most advantageous in my hands, was in the 
commencement of the eruptive fever to detract a quantity of blood, 
proportioned to the age and habit of the patient. To have the head 
shaved, and cold water and vinegar applied over the scalp. The body 



304 Callaghan on Epidemic Small-Pox. 

and extremities sponged with cold or tepid water, according to the 
temperature of the surface and the feelings of the patient. Then to 
exhibit as much of the sol. tart, antimonii as would produce a free 
emetic effect, following it up by aperients until the intestinal ca- 
nal was properly evacuated. A determination to the surface was 
afterwards kept up, by the use of the ox. antimonii cum phos. calcis, 
or the aq. acetatis ammonise. After the appearance of the eruption, 
gentle aperients, with the occasional use of an anodyne draught or 
the pulv. ipecac, et opii was generally all that was requisite. The 
apartments of the sick were kept cool, and as well ventilated as the 
locality of the place would admit. A mattrass was preferred to a 
feather bed, and the bed clothes as light as possible. The diet recom- 
mended was thin farinaceous gruel, with cooling acidulated drink. 
During the period of convalescence, the most rigid abstemiousness 
was strictly enjoined. 

Small-pox has not appeared in this country for about ten years be- 
fore. There was nothing peculiar in the season during the prevalence 
of this epidemic; the winter was cold, but not more so than usual. 
But the winter previous was remarkable for the quantity of rain that 
fell, and the absence of frost or snow. From report of the sex- 
tons of the various burial grounds in the city of Pittsburgh, there were 
said to be from fifty -five to sixty interments of persons who had died 
of small-pox during the epidemic. What proportion this may bear 
to the number of recoveries, it is difficult to say, as there is no re- 
gister kept, even of those who come under the care of the practition- 
ers of medicine, and many requested no medical advice. In some of 
the German settlements in the adjoining counties, they utterly refused 
to be vaccinated, or to have any medical aid when they were attack- 
ed by the disease in the natural way. Throughout the whole course 
of the epidemic, cases of varioloid occurred from time to time. But 
there were no deaths from this cause. During the spring months 
whooping cough made its appearance, and variola began to diminish. 
I had the opportunity of making only one post mortem examination; 
the following are the appearances as exhibited on dissection. C. D. 
cetat. SO, forty-eight hours after death. Cutis covered with variola 
of the distinct character. General appearance, of the intestines much 
injected with blood. Colon very much inflated. Gall-bladder tur- 
gid with bile of a black, viscid appearance. Pancreas exhibited a 
wasted appearance. Coats of the stomach injected with blood. An 
accumulation of hardened faeces near the arch of the colon. The veins 
on the meninges of the brain, turgid with blood. Venous congestion 
in the cerebrum, and the lungs full of dark, grumous blood. 

Pittsburgh, May, 1829. 



Peirce on Perforation of the Stomach, fyc. 305 



Art. VII. Perforation of the Stomach, without Ulceration or Soften- 
ing of its Coats. By Leonard Peirce, M. D. of Sutton, Massa- 
chusetts. 

FLETCHER BOTTOMLY, a native of Cheshire, England, came 
to the United States in June, 1827, then aged nineteen years; he fol- 
lowed weaving in a woollen manufactory. 

January 30th, 1829. — I was called about six o'clock this evening 
to visit him, but being from home, did not see him till nearly eight. I 
found him suffering from severe pain in the region of his stomach — feet 
and hands cold — pulse small and fluttering— countenance contracted 
and anxious. On inquiring of himself and his comrades, I learned that 
he had been as well as usual till about five this evening, when he was 
suddenly seized with a violent pain at the epigastrium, which soon 
extended downwards, but the seat of the pain remained at the stomach. 
When first seized, the pain was so violent that he cried out "lam 
dying," and threw himself upon the floor, holding his bowels with his 
hands, and pressing his body and thighs together. He was soon helped 
to his lodgings, which were a few rods distant, but was unable to walk 
upright, remaining bent, supporting himself with his hands upon his 
knees. The pain still continued violent, but was not now confined 
to his stomach, being occasionally as low down as the pubic region. 
Before I arrived he had taken an emetic of ipecacuanha, containing 
eight grains of calomel, which had vomited him twice with some re- 
lief; but the pain being now in his stomach, I gave him tepid water, 
which vomited him twice more, and he expressed himself considera- 
bly relieved. I now applied flannels wet with warm water to his ex- 
tremities, and gave him two grains of solid opium. His extremities 
soon became warm; pulse fuller and stronger; the pain abated consi- 
derably, and he fell asleep. I now directed one ounce of castor oil 
to be given every three hours until his bowels were moved, and left 
him for the night. 

31st. — At 7 A. M. I found him considerably prostrated, and in 
pretty severe pain. Pulse fluttering, and extremities cold. The 
bowels were rather fuller than natural, but were not tender on pres- 
sure; had passed a restless night, and taken the oil without producing 
any sensation of motion in his bowels; quite thirsty. I now divided 
two drops of croton oil into six parts, and directed one part to be 
given every half hour until the whole was taken, unless a motion was 
produced. Stimulants were given, and water gruel for drink. 
4 P. M. Had taken all the croton oil without producing the slightest 



306 Peirce on Per/oration of the Stomach, fyc. 

cathartic effect. Pulse much as in the morning; complained of 
considerable soreness in his bowels, which were rather fuller than in 
the morning. I should have given enemata, but for want of the proper 
apparatus was obliged to postpone them, and directed one ounce of 
castor oil to be given every hour, and put a blister upon the epigastrium. 
8 P. M. Directed an enema of decoction of senna, which passed oft' in 
about twenty minutes without bringing any faeces with it. In a few 
minutes I repeated the injection, which soon passed off unmixed with 
any alvine matter. I directed an enema of milk and molasses, of each 
four ounces, to be given every hour until his bowels were moved; 
continued the drink of water gruel; left him for the night. 

February 1st.'— 4 A. M. vomited a small quantity of a dark, fetid 
liquor, and in about fifteen minutes expired. 

I very readily obtained leave of the friends to examine the body, 
which I did at 2 P. M. ten hours after his death. 

The blister had produced very slight vesication, and the bowels 
were considerably tumid. On cutting through the parietes of the ab- 
domen, there was a sudden gush of liquor consisting of those articles 
he had taken into his stomach, castor oil, water gruel, &c. I observed 
to the bystanders that there was a rupture of the stomach or intes- 
tines, and I then supposed it to be from ulceration. After removing 
the fluids from the abdominal cavity with an injecting syringe, I laid 
open the abdomen, and proceeded to search for disease. The vessels 
of the omentum, and of the peritoneal coat of the intestines were con- 
siderably gorged with blood, but there were no unnatural adhesions 
between any of the parts. The mucous coat of the intestines was of 
a healthy appearance, except in some places in the small intestines 
there were minute scarlet dots thickly set together. The urinary 
bladder was entirely empty, and of a healthy appearance. Kidneys 
healthy. The liver was of a pale ash colour externally, and inter- 
nally much paler than natural. On arriving at the stomach, I found 
about half an inch above the pylorus, on the anterior part, an open- 
ing about two and a half lines in diameter. This had the appearance 
of having been punched out with a cutting instrument, and was not 
much unlike the holes made in harness for the buckle tongues, but 
the edges were not quite so well defined as though cut with an edged 
tool. There was no appearance of disease about the perforation, 
either externally or internally, except that the mucous lining of the sto- 
mach was filled with black and brown dots of about the same appear- 
ance, except in colour, as the grains of Indian meal taken in the 
gruel. 

Bottomly was of a melancholic temperament, tall, spare, and tern- 



Coxe on Wounds of the Heart. 307 

perate in the use of spirituous liquors. He was a voracious eater, de- 
vouring as much at his regular meals as two common eaters, and fre- 
quently eating between meals, and always taking some cold food just 
before going to bed. He had for several years previous to his death 
been afflicted with purulent ophthalmia. Since the time of his arri- 
val in this country he had been very costive, generally not having a 
stool oftener than once a week. He had within three or four months 
of his death, three small, hard, red, or rather purplish tumours di- 
rectly in the pit of his stomach, which were very sore and painful, 
slow in forming, and difficult to cure. He usually applied a plaster 
of shoemaker's wax to them, which caused them to ulcerate and dis- 
charge a sanious, bloody matter, and then they would heal. The 
last one was a little previous to his death, but had at the time got 
entirely well. 

Sutton, April 10, 1829. 



Art. VIIT. Some Observations on Wounds of the Heart. By John 
Redman Coxe, M. D. Professor of Materia Medica and Pharmacy 
in the University of Pennsylvania. 

IN the last number of this Journal, p. 263, is a notice of a very in- 
teresting case of gun-shot wound of the chest, in which the patient 
lived sixty-seven days after the accident, and on post mortem exa- 
mination, three shot were found lying loose in the cavity of the right 
ventricle, and two in the right auricle. 

The case is of that interesting nature, that it strongly arrested my 
attention^ more especially, since the affirmation of this wound of the 
ventricle, and its subsequent healing, is in direct opposition to every 
recorded case of the penetration of the cavities of the heart, of which 
I had collected a considerable number, in my Memoria Medica. Af- 
ter considerable deliberation, I have therefore ventured to draw up 
the following observations, in opposition to the opinion entertained 
by those respectable physicians who have recorded the case ; hoping 
that they may either change those opinions, or that they may have 
an additional mass of facts on the subject, that may correct my own 
if erroneous. 

That wounds of the heart are invariably fatal, when penetrating 
its cavities, is confirmed by every case to be found in the records of 



308 Coxe on Wounds of the Heart. 

our science.* That such wounds are necessarily so, merely from the 
structure of that viscus, is not so evident! the fatality arises from the 
nature of its functions, and the absolute tendency to death, which, 
the unarrested discharge of blood, must inevitably promote; rather 
than from any incapability of its admitting of the same salutary in- 
fluences of nature, that are conspicuous in every other muscle of the 
body; and hence there is no deficiency of recorded healing up of su- 
perficial wounds and ulcerations, &c. of the heart, where a due adap- 
tation of cure had been sedulously attended to. It is also obvious, 
from the cases I shall adduce, that life has been prolonged even up 
to the sixteenth and seventeenth days, and through all the interme- 
diate period; but which must obviously have been the result of some 
mechanical cause, by which the blood was not able to pour forth in an 
acute, but only in a chronic manner, if I may use these terms for this 
particular view of the subject. In none of these cases was the wound 
healed, nor was life in any of them preserved, even during one-third 
part of the period of the case which has given rise to these remarks. 
I am consequently led to believe, that in this case, the shot thus found 
within the cavities of the heart, reached them by a very diiferent con- 
veyance than that pointed out ! — and that the spots assumed as eschars 
of their transmission, were but the marks of superficial injury, or 
mere lesion of the external surface by shot, that never penetrated be- 
neath that surface. 

I shall now detail some of those cases I have adverted to, in hopes 
that they will tend to corroborate my previous remarks, as well as 
the few that will subsequently be made. 

Parey, lib. 10, cap. 30, gives an account of a gentleman, who, 
fighting a duel, received a wound which penetrated his heart, so large 
as to contain his finger; yet he struck some blows afterwards, and 
followed up his flying enemy above two hundred paces before he fell 
down dead. 

Frederick 3d of Denmark, is reported to have shot a stag through 
both ventricles of the heart, who ran fifty paces before he fell. 

* I speak of wounds from fire-arms or swords, &c. Certain it is, that acu- 
puncturation has been effected, without death ensuing; but there is little ana- 
logy between this and the former. Glandorpius relates on the authority of 
Sanctorius, that the heart of a rabbit was perforated by a sharp instrument, the 
animal being alive at a period of several months. I have heard it stated that a 
physician of this city, intent on prosecuting some experiments on acupunctu- 
ration, had actually introduced a needle into the substance of his own heart. I 
know not how true this is, but if so, he is yet active, and apparently in perfect 
health. 



Coxe on Wounds of the Heart. 309 

Muller relates the case of a soldier, who lived fifteen days after 
a wound of the right ventricle of the heart. Heer relates several 
cases of a similar nature, and Tulpius mentions one who survived a 
similar wound for two days. Obs. lib. 2, cap. 18. 

Saviard, Surgery, Obs. 113, states the case of a man, who lived 
four or five days after a wound, in which the heart had been thrust 
through, from the right ventricle into the left, across the septum me- 
dium; he ascribes this prolongation of life to the blood forming clots, 
after filling up the cavity of the thorax, by which the mouths' of the 
wounds in the ventricles were stopped. Unquestionably this is a 
cause of temporary survival at times — another may be, the slanting 
direction of the wound, opening like the ureter in the bladder, so as 
to form a valvular apparatus ; other mechanical explanations may 
probably be assigned. 

Vander Wiel, Centur. Obs. Rar. vol. 2, p. 258, I*eyd. ed. 1727, 
refers to Muys, to Tulpius, and others, already, or presently to be 
mentioned. One case referred to is that of Heers, (Obs. Med. lib. 1, 
c. 2, fol. 115,) in which, (the heart penetrated by four balls,) the 
person survived fifteen days. 

Rhodius, Obs. Med. cent. 2. cap. 39, mentions one who lived 
nine days after a wound of the heart. 

T. Bartholine, cent. 1. hist. 77, states a case where a person 
wounded through the heart, walked a considerable distance, and sur- 
vived five days. He adverts also to the stag above mentioned, as be- 
ing shot through both ventricles, and in which the wound was large 
enough to admit the extremities of three fingers. He has, cent. 3, 
hist. 12, moreover, detailed from Bacon, (Hist. Vit. et Mort.) a 
curious case, the outlines of which may be seen in the Esculapian 
Register, p. 125, of a man, who attentively contemplated his own 
heart, after it had been cut out from his body, and of another who 
was heard to speak several words of prayer, after the executioner 
had his heart in his hand. 

Acosta, in Hist. Ind. lib. 5. cap. 22, mentions an Indian, whose 
heart being cut out in sacrifice, yet spoke to the Spaniards. 

S. Blancard, Op. Med. and Chir. vol. 2, p. 110, relates the case 
of a soldier, who fighting, received a thrust under the left breast, 
penetrating the heart; he did not however cease fighting, but follow- 
ed up his antagonist two hundred paces before he fell, the wound 
being capable of admitting the forefinger. This case I believe must 
be the same that is above reported from Parey; it is not so stated by 
Blancard, who has, however, so much regard for it, that he has re- 
No. VIII.—August, 1829, 40 



510 Coxe on Wounds of the Heart. 

peated the case exactly at p. 585, though why, I cannot well ima- 
gine. 

Diemerbroeck, in his Anatomy, Lond. fol. 1694, p. 310, states 
from Schenkius, that a student received a wound through both his 
ventricles, yet he ran the length of a whole street, and was in per- 
fect sense of mind for an hour; he refers also to several of the pre- 
ceding cases; and to others, from Sennertus and Johnson. He says 
likewise, that he himself saw, and dissected a young man in 1660, 
who was wounded by a sword, and walked fifty or sixty paces before 
he fell j being carried home, he came to himself, and lived nine days 
eight hours after the wound was received. It had penetrated directly 
into the upper part of the right ventricle. 

Antonius Benevenius, in his surgical works, (An. 1529,) has a 
chapter entitled " Cordis pars patefacta inciso abscessu, & aeger ta- 
men restitutus. " Not having his work, I know not what are the par- 
ticulars of this case. It is probable however that the incision of the 
abscess, had no connexion with the interior of the heart. 

Muys, in his " Rational Practice of Chyrurgery," p. 200, states 
that he witnessed " a Jew Arnhemium, wounded in the very sub- 
stance of his heart, who, notwithstanding, twice a day, for six days 
together, before he died, came to his house on foot to have his wound 
dressed." 

This writer says moreover, " that Galen relates as an eye witness, 
that the pericardium being corrupted, the heart lay sufficiently bared 
in the breast of a certain sick man, who notwithstanding recovered." 
I have not been able to find this statement in Galen; but he has in his 
treatise " de locis affectis," lib. 5, the following observation. " Si ad 
ventrem cordis, prsecipueque sinistrum, aliquando penetraverit vul- 
nus, protinus cum multo sanguine vitam exhalabit animal. Si vero 
non ad ventrem usque pertingat, sed in cordis substantia consistat 
vulnus, ex ita affectis aliqui non solum ea die, qua vulnerati fuerunt, 
sed sequenti quoque nocte potuerunt vivere." 

That the heart is however in itself not very acutely sensible, is 
proved by its having been the seat of several severe diseases, without 
the patient suffering much; and the extraordinary operation not many 
years past, performed by Richerand, is equally a proof of the same. 
The most singular example of the fact, is, in my opinion, one detail- 
ed by the great Harvey, is his treatise " de generatione Animalium," 
and which, as I have never seen it quoted, I consider worthy of in- 
troducing in this place. See Exercitatio 52, entitled "De Sanguine, 
prout est pars principalis," p. 198, ed. Amst. 1662, 12mo. in which, 



Coxe on Wounds of the Heart. 311 

amongst other matter, he attempts, by the relation of the case, to 
demonstrate the little sensibility of this important viscus. I give the 
principal outline. 

A noble youth, the eldest son of the illustrious Viscount of Mont- 
gomery, in Ireland, whilst yet a boy, by an unfortunate fall, fractur- 
ed the ribs of the left side. An abscess formed, and discharged pro- 
fusely; and so continued for a long time, as related to Harvey by 
himself and others. About the age of eighteen or nineteen, he tra- 
velled through France and Italy, and from thence came to London. 
During all this period, a very large and open space continued in his 
breast, so that the lungs, as it was supposed, could be therein both seen 
and touched. This being told to King Charles, as a great wonder, he 
immediately sent me to examine the young man. I found him appa- 
rently healthy, and explained the cause of my visit by the king's 
command. The part was immediately exposed to my view. The 
dressings being removed which he wore as a defence against any ex- 
ternal injury, I saw, says Harvey, an immense cavity in the breast, 
into which I could readily pass my three forefingers and thumb. At 
the same time I noticed at its entrance a certain fleshy protuberance, 
reciprocally moving inwards and outwards, and which I carefully 
handled, (tractavi.) Astonished at the novelty of the case, again and 
again I examined every part, and diligently and sufficiently investi- 
gated it. Assuredly a large and old ulcer had miraculously healed, 
and was on its inner part, covered with a membrane, and invested 
with a firm skin about its edges. The fleshy part, which, at first sight 
I had taken to be a luxuriant growth of flesh, and which others sup- 
posed to be a part of the lungs, from its pulsation and difference of 
stroke, (a hand being applied conjointly to the carpus and heart,) as 
also from attending to the respiration, I plainly perceived that it was 
not a part of the lungs, but the heart itself, which a fungous flesh, as 
in sordid ulcers, covered exteriorly. This was daily cleansed by 
warm injections, and the dressings replaced. Which done, he exer- 
cised in the way most agreeable to him, and enjoyed his existence. 

I carried this young man, says Harvey, to the king, that he might 
himself see, and feel with his own hands, so strange a thing; viz. 
that in a living and healthy man, without any injury, he might per- 
ceive the heart itself beating, and its ventricles pulsating, and touch 
it with his hands. Both the king and myself found the heart to be 
devoid of sensibility, for the young man, (except when looking, or by 
the sensation on the external skin,) knew not when we touched it. 

I cannot resist inserting the following quotation from his 68th Ex- 
crcitation, p. 294, as an evidence that we have probably, by means 



312 Coxe on Wounds of the Heart. 

of the civil wars, lost some very important works of this learned 
man, and which we must deplore, as never likely to be regained: — 

" Atque haec dum agimus, ignoscant mihi niveae animae, si (sum- 
marum injuriarum memor) levem gemitum effudero. Doloris mihi haec 
caussa est: cum inter nuperos nostros tumultus, & bella plusquam 
civilia, serenissimum Regem (idque non solum Senatus permissione, 
sed & jussu) sequor, rapaces quaedam manus, non modo aedium mea- 
rum supellectilem omnem expilaruntj sed etiam, (quae mihi caussa 
gravior querimoniae,) adversaria mea, multorum annorum laboribus 
parta, e musaeo meo summanarunt. Quo factum est, ut observationes 
plurimae, (praesertim de generatione Insectorum,) cum reipublicae 
literariee, (ausim dicere,) detrimento perierint."* 

* It is rather a singular circumstance in the annals of medicine, that so few 
instances are recorded of the actual exposure of the heart, without injury. The 
two above mentioned were the only cases I had met with in my reading-, until 
within a few days; when accidentally consulting the writings of Galen for a dif- 
ferent purpose, I found in his 7th book, " De Anatomicis Administrationibus," 
Chap. 12th and 13th, as remarkable a case as either of those, from his own au- 
thority, (Ed. Ven. 1586, 7 vol. fol. — Vol. 1. p. 97,) and which is certainly de- 
serving of being quoted. 

At the conclusion of an excellent chapter, (12th,) entitled " Administratio 
Cordis 8c Pulmonis in vivo Animali," he points out the insensibility of the heart, 
(if we may so say,) in the following words. " At Corde denudato omnes ipsius 
functiones incolumes servare tibi propositum est, quemadmodum etiam servan- 
tur; siquidem & respirare similiter &. clamare animal vides: ac si a vinculis ip- 
sum liberes, currere, sicut prius consuevit. At, si vulnus vinculis adhuc com- 
primas, etiam cibum assumere, si esuriat, conspicis: 8cbibere, si sitiat. Et quid 
miri est? cum Marylli Mimographi puer curatussit, vivat que adhuc, etsi cor ali- 
quando ipsifuerit detedum." 

Whether this case may not be sufficient to establish Galen as a bold and re- 
solute surgeon, may be perhaps variously viewed by different readers. To me 
however it affords most ample proof of his anatomical skill, and of his prompt 
and sagacious decision; to which nothing but a free use of the dissecting knife 
on the human subject, could have possibly led him. In vindicating him from the 
continual assertions of servile copyists from each other; anxious to traduce the 
character of this great man, and to bring him down to a level with themselves, 
I venture to insert the case as related by himself; and I request that it may be 
borne in mind, that Galen lived nearly eighteen hundred years ago! 

Cap. 13. "Historia pueri persanati, cui os pectoris excisum erat, & involucrum 
cordis computruerat." 

"Quoniam vero semel curati pueri mentionem feci, nihil mali fuerit omnia, 
quae ipsi evenerunt, percensere. Nam propter historic utilitatem, etiam si ad 
prsesens opus nihil attineat, non abs re fuerit ea commemorare: Ictus puer ille 
in pectoris osse in palaestra, neglectus primum est, deinde parum probe cura- 
tus. Post menses quatuor pus in parte percussa apparuit: hoc auferre cogitans 



Coxe on Wounds of the Heart. 313 

Many other examples of a similar kind I could no doubt collect. 
These are however sufficient to show, that although life may be pro- 
longed from accidental causes, even for several days, yet that no so- 
litary case exists, wherein a wound penetrating the heart, has ever 
been known to heal. I cannot, therefore, for an instant suppose, 
that in Dr. Randal's case we can perceive an established fact of an 
opposite character; or that, presuming the shot to have penetrated 
the heart, any other event than that of death was to be anticipated. 
The whole circumstances of the case, if strictly scrutinized, forbid 
us, I think, to admit of that view which is taken of the subject. I 
have already said, that the scars seen, were probably only the relics 
of a superficial injury sustained, from the shot not possessing an im- 
pulse sufficient to go deeper, or perhaps glancing from the ribs. If a 
scar is sufficient to prove such an anomaly in a case like this, then 
indeed we may accredit a case of Cabrolius, who " found in the 
heart of a thief, that was hanged, the remaining scar of a wound that 
had been cured, about two fingers long, and about the thickness of a 
sixpence." This, (which I quote from Diemerbroeck, p. 311,) will, 
I presume, scarcely be considered as proving the wound to have pass- 

Medicus puerum incidit, & (ut putabat) subito ad cicatricem vulnus perduxit; 
postea rursus inflammatio oborta est, mox quoque abscessus: iterum sectus puer 
est, nee amplius cicatrix obduci potuit. Quapropter herus ipsius pluribus Me- 
dicis convocatis, inter quos ego quoque eram, deliberare super curatione pueri 
jussit. Cum autem sideratio, quam Graeci g-qumxov appellant, pectoris ossis af- 
fectus videreter omnibus, appareret autem 8c Cordis a sinistra ipsius parte 
motus, nemo affectum os excidere audebat: quippe arbitrabantur thoracis per- 
forationem necessario futuram. Ego autem citra vocatam proprie a Medicis 
perforationem adhibitum pollicitus sum me excisurum: de absoluta vero cura- 
tione nihil promissi, cum incertum esset, num aliquid ex iis, quae pectoris ossi 
subjacent, fuerit affectum, 8c quatenus affectum: Itaque regione detecta amplius, 
nihil in pectoris osse laesum apparuit, quam quod ab initio statum vidibamus: 
quare etiam magis ad manus operationem venire sum ausus, cum jam fines, 
quibus arteriae 8c venae subhaerescunt, utrinque illaesi occurrissent: cum vero af- 
fectum os ab eo potissimum loco excidissem, in quo talis pericardii vertex adnas- 
citur : cumque nudum cor appareret, (quippe involucrum ipsius computruerat,) 
ob hoc quidem haud bonam statim spem de puero habebam, attamen in totum 
brevi temp oris spatio persanatus est: quod non accidisset, si nemo affectum os 
abscindere ausus fuisset: nemo autem tentasset, nisi in administrationibus anato- 
micis prseexercitatus," 8cc. 

I cannot believe that a man who writes and acts thus, could have limited his 
dissections to brutes alone. And if a good translation were made of his princi- 
pal writings, our present readers would find very much therein, that within the 
last fifty years has been claimed by others! Thanks to our ignorance of the au- 
thors of the olden time ! 



314 Coxe on Wounds of the Heart, 

ed into the cavities, and yet the argument is the same. The chief 
advantage in the case of Dr. Randal's patient is, that the shot were 
in the cavities of the heart; and the only question as to the difference 
of opinion between myself, and the apparently conclusive evidence 
of the senses, by autopsic demonstration, is, how they got there? 

May I ask, whether, in a wound, or rather five wounds penetrat- 
ing the heart, little or no haemorrhage would be likely to take place, 
either at the instant, or at some period before the adhesive process 
was completed; is it likely, in a wound made by the " whole charge" 
of shot, the greater part of which seem clustered in the lungs, that 
in the course of a week the wound would be healing, and in three or 
four weeks be completely cicatrized, while such perforations existed 
in the ever moving viscus ? Is it likely that three shot would conti- 
nue permanently during sixty-seven days in the right ventricle, and 
two in the auricle? and how indeed, from the location of the wounds, 
could the latter have gotten into the auricle ? Are we to suppose, 
that during sixty-seven days, these five shot remained unmoved, ex- 
posed to the full torrent of the circulating stream ? Would this ra- 
pid motion not rather have impelled them into the pulmonary artery; 
and driven them to a part whose calibre they could not pass; and when 
of course dissection might have traced them ? In opposition to these 
difficulties, where is the dilemma, if we suppose, that, as the lungs 
were loaded in various parts with shot, the deranged state of 
those vascular parts, inducing suppuration, &c. should, (although the 
external wound might heal;) nevertheless, after that period, bring on 
hectic fever and other symptoms; and that some of the vessels, ero- 
ded or absorbed by the pressure of a leaden shot, might at length 
permit some of the cluster to fall into its cavity; and at the moment 
of death, by mere gravitation, find their way into the cavities of the 
heart, in which they were seen and detected ? Had the idea suggest- 
ed itself, it is not impossible, that even other shot might have been 
found, that might have fallen into the vena cava, and only been ar- 
rested by some distant valve ! 

By such, or some process of a similar description, can I alone sup- 
pose that we can plausibly explain the various circumstances of 
the case! The actual penetration of the cavities of the heart, is alto- 
gether problematical; and if the shot did really find their way in the 
manner affirmed by the gentlemen who relate the case; I can only 
say, that it is an anomaly as regards the wounds of the heart; and 
being in total opposition to every hitherto recorded fact, it must stand 
as an insulated one in the annals of medicine! 



Heustis on Hernia Cerebri. 315 



Art. IX. Inquiry into the Causes, Nature, and Treatment of Her- 
nia Cerebri. By J. W. Heustis, M. D. of Gahawba, Alabama. 

1 HE importance of the integrity and sound condition of the brain 
to the healthy, rational, and perfect performance of the various intel- 
lectual and corporeal functions of the human system, is a physiologi- 
cal fact, which few at the present day would have the scepticism or 
heresy to deny. Yet exalted as are the offices of this organ, expe- 
rience teaches us that it is capable of enduring serious injury, with- 
out destroying or endangering life. That these injuries impair to a 
greater or less degree the functions of the animal economy, is obvi- 
ously true; but the wonder and surprise are, that in many instances 
the effect should be so apparently trivial and disproportionate to the 
cause. Thus, experiments on the inferior orders of the animal crea- 
tion show that the brain may be sliced away to near the basis of the 
skull without the immediate destruction of vitality; and even in the 
human subject the skull may be extensively fractured and driven in, 
the periosteum abraded, the dura and pia maters lacerated, and 
even a portion of the brain lost in consequence of the injury, and yet 
the patient recover. If then the brain can suffer such severe and ex- 
tensive injury without destruction to life, the inquiry might suggest 
itself, what are the extent and degree to which this organ may suffer 
injury and violence without endangering the life of the individual. 
But as we have no scale by which we may accurately measure the 
grades of suffering and derangement of the animal system, we must 
leave this inquiry where we found it. This, however, we do know, 
that if the external violence or internal lesion exceeds a certain de- 
gree, death is the inevitable consequence. 

Mere fracture of the skull, although extensive, is not generally 
fatal. And in cases of external violence done to the head, as from 
blows and falls, death is perhaps owing more to concussion than to 
pressure upon the brain, either from the bone externally, or from ex- 
travasation of blood within. It is true, that in cases of severe frac- 
ture, the intellect is generally deranged and impaired, the person 
lying more or less comatose and insensible, the stomach sympatheti- 
cally affected, weak and irritated, rejecting its contents; the eyes 
squinting; the limbs paralytic, &c. ; yet the presumption is that most 
of these symptoms are owing to concussion, which is always a neces- 
sary consequence, in a greater or less degree of such violence as 
causes a fracture of the bones of the cranium; and what is more con- 
clusive upon this point is that such symptoms may, and do occur 



316 Heustis on Hernia Cerebri. 

without any fissure or depression having taken place. But although 
in injuries of this nature, life may not be destroyed by the mere pres- 
sure of the bones upon the subjacent cerebrum, yet where symptoms 
of the character above mentioned exist, we are certain that the injury 
received is urgent and severe, and such as demands the immediate 
interference and aid of medical discretion and surgical skill. The 
worst fractures that I have ever seen, were unaccompanied with la- 
ceration of the integuments ; still the touch, the unequal feel, the 
tumid and ridgy hardness, the puffy softness, and in addition to all, 
the stupor and abolition of intellect, were strong and positive assu- 
rances of the extent and severity of the subjacent mischief. Upon 
making a crucial incision and dissecting up the integuments, we find, 
perhaps, extensive fissures in different directions; sometimes laying 
open the sutures, extending from ear to ear, or stretching obliquely, 
and bursting open the socket of the eye, with a considerable portion 
of the coronal or parietal bones broken and depressed ; and not 
unfrequently a portion of the brain forced out upon the surface of 
the skull in the same manner that a heavy blow, or great pressure 
upon the yielding ice, causes the subjacent fluid to escape by the 
nearest opening. Now, as the cerebral mass fills completely the cavity 
of the skull, any considerable pressure upon it from any cause, or in 
any part, more than it is able to sustain, must produce a tendency in 
the brain to escape by any opening that may accidentally exist; as it 
is in this way, from great external violence and injury done to the 
brain and its membranes that hernia cerebri owes its origin, the fore- 
going remarks I trust will not be considered irrelevant to the sub- 
ject. 

In many instances these fungi or cerebral hernia are not attended 
with any dangerous or alarming symptoms; and it would therefore 
seem that the more aggravated constitutional affections, which some- 
times accompany their existence, have not so necessary a connexion 
with these fungi as cause and effect, as they are owing to meningeal 
and cerebral inflammation, and extravasation of lymph into the ven- 
tricles, as the effect of such inflammation occasioning pressure of the 
encephalon, and thence giving rise to the various symptoms connect- 
ed therewith. This affection rarely takes place, unless great injury 
has previously been sustained by the brain and its membranes; and 
a frequent cause appears to be the laceration of the meninges, from 
points and edges of the broken pieces, and spiculae of bone detached 
from the inner table of the skull, and penetrating into the substance 
of the brain. Another circumstance favouring its occurrence, is the 
loss of a considerable quantity of bone, more especially if at the same 



Heustis on Hernia Cerebri. 317 

time a laceration of the membranes should have taken place; from 
both these causes, the natural support of the brain is taken away, and 
an increased momentum of blood being determined to the part by the 
excited and inflammatory action of the vessels; the latter, instead of 
a healthy secretion, throw out this exuberant and fungus excrescence. 

Previously to its appearance, however, where the intellect is un- 
impaired, the patient is affected with more or less fever, preceded by 
shivering and chilliness, and accompanied with pain in the head. 
ft His countenance is of a pale, dirty, cadaverous yellow. As the 
tumour increases, he has frequent sickness, is giddy, and reels like 
a drunken man."* After this, the pulse becomes slow and weak; he 
betakes himself entirely to bed, being no longer able to sit up; his 
mind becomes wandering and incoherent; he lies oppressed, and his 
pulse is a mere tremulous motion of the artery. In more aggravated 
cases, the symptoms of compression and irritation of the brain are 
more considerable and violent. The patient becomes delirious; is 
incapable of performing any voluntary motion; the muscles of the 
face and limbs are affected with convulsions; the countenance is dis- 
torted; the eyelids fixed and squinting; the jaws are spasmodically 
closed, or affected with convulsive motions, occasioning an involun- 
tary grinding of the teeth. The tongue is either paralytic, or rigid 
with spasm, and articulation thereby rendered impracticable. Some- 
times the convulsions extend to the whole body, and there is a perfect 
opisthotonos. 

Where this affection comes on from gun-shot wounds of the head, 
in which the skull and membranes of the brain have been much bro- 
ken and lacerated, accompanied by symptoms of constitutional de- 
rangement above mentioned, the event is often, and perhaps general- 
ly fatal. But when in cases where these symptoms have come on to 
a considerable degree, provided the person has been previously 
healthy, and the constitution unimpaired by sickness or intemper- 
ance, the danger may often be subdued, and life preserved by pro- 
per treatment. 

Post mortem examinations in this disease have discovered traces of 
high inflammation in the pia mater, and the ventricles of the brain 
filled with a serous fluid, mixed with blood. 

With respect to the nature and causes of hernia cerebri, consider- 
able difference of opinion exists among practitioners of the present 
day; this want of unanimity in theory has accordingly led to a cor- 
responding diversity of practice. By some, these affections are con- 

* Charles Bell, Operative Surgery, 
No. VIII.— August, 1829. 41 



318 Heustis on Hernia Cerebri. 

sidered as consisting, for the most part of coagulated Wood. By the 
older physicians they were supposed, from their pulsatory motion, 
to be aneurisms; others imagined them to be occasioned by an ulcera- 
tion of the cerebral mass, whilst some are of opinion that they are 
mere excrescences, occasioned by a morbid action in the vessels of 
the brain. It would appear, however, from the most generally re- 
ceived notions, that the opinion of Mr. Abernethy in relation to this 
subject, is not supported by the concurrent sanction and experience 
of others; nor does it appear to comport with that accuracy of obser- 
vation and just discrimination, which we might reasonably look for in 
a gentleman of such reputation and experience in his profession as 
Mr. Abernethy. His opinion appears to be that these cerebral tu- 
mours consist of coagulated blood, eifused from some wounded or 
diseased vessel beneath the surface of the brain. Relating the case 
of a young man who had died of this disease, he remarks that upon 
examining the tumour it was found larger than before, and of a dark 
colour, with an irregular granulated surface, which appearance seem- 
ed to be owing to coagulated blood which adhered to its surface, as 
the part had bled so much that one-half of the cap which the man had 
worn, was rendered quite stiff by it. "A part of this tumour being 
cut off where it was lacerated, appeared to consist of coagulated blood 
of a fibrous texture." 

His reasoning and deductions from these premises are as follows:— 

" The appearances on dissection clearly explain the cause of the symptoms 
which had taken place, and rendered it evident, that the disease under which 
this man had chiefly laboured, was inflammation of the pia mater. The nature 
of the tumour, also, was not less satisfactorily pointed out. It was plain, that in 
consequence of the brain being injured to some depth beneath the surface, dis- 
ease of the vessels and consequent effusion of blood had ensued? that the effu- 
sion was, for a while, restrained by the superincumbent brain and its mem- 
branes? but these gradually yielded to the expansive force exerted from within, 
and at last giving way altogether, the fluid blood oozed and coagulated upon 
the surface of the tumour. It appears very probable that the disease frequently 
described by the term hernia cerebri, consists, as in this instance, of a tumour 
formed by coagulated blood; for an organized fungus could hardly be produced 
in so short a time as that in which these tumours are generally formed." 

From a note subjoined at the end of his observations on this com- 
plaint, it appears that Mr. Abernethy himself only considered that 
form of this disease which corresponds with the above description, as 
a sub-species, and one, it would seem, of rather rare occurrence. 
He observes, in his note, that he never meant, in the recital of the 
cases above referred to, to deny, that the surface of the brain, when 
exposed and irritated, would throw out a vascular fungus; and that 



Heustis on Hernia Cerebri. 319 

it was only intended to describe a species of those appearances which 
had been denominated fungus or hernia cerebri. He further remarks, 
that in all the cases of true fungus cerebri which he had seen, when 
he first wrote the foregoing, the fungus grew so slowly, that it could 
not be mistaken or confounded with the appearances which took place 
in the cases he had cited. With what reason or propriety then, could 
Mr. Abernethy presume to erect a subordinate variety of this disease 
into a generic character, and founding thereon its causes, nature, 
and mode of treatment ? Mr. Abernethy objects to this fungus being an 
organized substance from the rapidity of its growth. But, in answer to 
this, it may be remarked, that it is the nature of most fungi and ex- 
crescences to be extremely rapid in their growth. The part thus pro- 
duced being destitute of healthy granulations, there is, consequently, 
not required in its formation that perfect elaboration of sound, assi- 
milated, animalized secretion, which takes place in every portion of 
the body when unaffected by morbid action. I do not, however, pre- 
tend to deny, that fungus-like excrescences from the brain, similating 
hernia cerebri, have never occurred; though it is presumable that such 
cases are rare, and as they are easily distinguished, ought not to be 
confounded with the disease under consideration. The same may be 
said of that protrusion of the cerebrum and its meninges proceeding 
from internal suppuration, and consequent collection of matter be- 
neath the surface of the brain. It is, however, possible, and even 
probable, that in some cases these fungi and abscesses may have 
a cotemporaneous existence: from the pressure of the membranes, 
against the rough and sharp edges of the bones, where the fracture 
had taken place, their integrity is destroyed by sloughing and sup- 
puration, and the abscess may thus find its way into the substance of 
the brain; at the same time, a locally increased, vascular, inflamma- 
tory action existing, a fungus excrescence shoots up, instead of a de- 
position of healthy granulations. 

In this affection there is always observable a very considerable pul- 
sation in the part; not depending, as Professor Blumenbach, and 
the older physiologists believed and affirmed, with respect to the mo- 
tion of the brain, upon the process of respiration, but produced en- 
tirely by the action of the arteries. That any doubt should ever have 
been entertained in relation to this matter is, indeed, the more asto- 
nishing, since, to the senses themselves, this cerebral motion is in 
perfect synchronous correspondence with the action of the arteries in 
other parts of the body. One thing worthy of observation in hernia 
cerebri is, that the more rapid the growth of this excrescence, the 
more perceptible and stronger, is this pulsation; showing that there 



320 Heustis on Hernia Cerebri. 

exists an increased determination of blood to the part, in the same 
way as in other instances of local inflammation and excrescences. 

As far as my own observation extends, I am warranted in the opi- 
nion that this disease consists of a fungus excrescence from the brain, 
in consequence of preceding violence done to this organ, followed 
by increased vascular action in the part affected, producing an exu- 
berant secretion of cerebral matter, which, being unrestrained in con- 
sequence of the deficiency of the natural support and covering of the 
brain, protrudes through the opening in the skull, and rises in the 
form of an unsightly mass above the surrounding integuments of the 
head. Upon removing excrescences of this description with the knife, 
they have appeared to be perfectly organized, of the colour and con- 
sistence of the cineritious portion of the brain, plentifully supplied with 
blood-vessels both arteries and veins, and which bled freely on being di- 
vided. If these fungi were merely lumps of clotted blood, according to 
the notion of Mr. Abernethy, we should never find such a perfect re- 
semblance to the organization of living matter. True, they are in a 
great degree, and perhaps entirely insensible; but so, likewise, I be- 
lieve, is the substance of the brain; and the same thing holds true 
with respect to various other healthy organizations of the body, as 
the bones, cartilages, fat and marrow. In further proof of the vitality 
and organization of hernia cerebri, I have known them after having 
protruded through the opening in the cranium, and acquired consi- 
derable size, become firmly attached to the integuments of the head 
and the surrounding parts; thence deriving an increase of vascularity 
and nutrition from the anastomosis of vessels, and to which the same 
increased and morbid action was communicated. I know it was the 
opinion of Mr. Hunter, an opinion subsequently adopted by Mr, 
Abernethy and others, that a coagulum of blood, formed by acciden- 
tal extravasation in any part of the body, might subsequently become 
a living organized substance, possessing its own blood-vessels and 
nerves, with a principle of individual increment and nutrition, and thus 
laying the foundation for tumours and excrescences. In the course of his 
experiments and observations, instituted with a view to establish a 
living principle in the blood, Mr. Hunter was naturally induced to 
attend to the phenomena which took place, when that fluid was ex- 
travasated, whether in consequence of accidental violence or other 
circumstances. The first change which took place he found to be co- 
agulation: and the coagulum, thus found, if in contact with living 
parts, according to Mr. Hunter, did not produce an irritation similar 
to extraneous matter, nor was it absorbed and taken back into the 
circulation, but, in many instances, preserved its living principle, 



Heustis on Hernia Cerebri, 321 

and became vascular, receiving branches from the neighbouring 
blood-vessels for its support; it afterwards underwent changes, ren- 
dering it similar to the parts to which it was attached, and which 
supplied it with nourishment. Mr. Hunter's opinion was, that when 
these coagula are not disturbed by the motion of the parts, they rea- 
dily formed an intimate attachment through the intervention of new- 
formed vessels. But that when there is considerable motion in the 
part where this coagulum takes place, the attachment becomes di- 
minished by the friction, rendering it, in some instances pendulous, 
and in others breaking it off entirely. This circumstance he illustrates 
by an instance which occurred in the examination of a dead body, in 
which, upon dissection, ' < there appeared lying upon the peritoneum a 
small portion of red blood, recently coagulated; this, upon examina- 
tion, was found connected to the surface upon which it had been depo- 
sited, by an attachment half an inch long, and this neck had been 
formed before the coagulum had lost its red colour. This, steeped in 
water so as to become white, appeared like a pendulous tumour." In 
this way he explains the formation of those pendulous bodies, which 
sometimes occur attached to the inside of circumscribed cavities, as 
the knee-joint, for instance, the extravasated blood assuming the 
nature of the part in which it is effused. The cartilages in the knee- 
joint, therefore, appeared to him to originate from a deposite of co- 
agulated blood upon the end of one of the bones, which had acquired 
the nature of cartilage, and had afterwards been separated. Mr. 
Abernethy, who adopts this opinion, pursues the subject as fol- 
lows:—* 

" Had vessels shot through the slender neck, and organized the clot of 
blood observed by Mr. Hunter, it would then have become a living- part, it 
might have grown to an indefinite magnitude, and its nature and progress would 
probably have depended on the organization which it had assumed. I have in 
my possession, a tumour, doubless formed in the manner Mr. Hunter has de- 
scribed, which hung pendulous from the front of the peritoneum, and in which 
the organization and consequent action have been so far completed, that the 
body of the tumour has become a lump of fat, whilst the neck is merely a 
fibrous and vascular texture. There can be little doubt that tumours form every 
where in the same manner. The coagulable part of the blood being either ac- 
cidentally effused, and deposited in consequence of disease, becomes after- 
wards an organized and living part, by the growth of the adjacent vessels and 
nerves into it. When the deposited substance has its attachment by a single 
thread, all its vascular supply must proceed through that part; but in other cases 
the vessels shoot into it irregularly at various parts of its surface. Thus, an 
inorganized concrete becomes a living tumour, which has at first no perceptible 
peculiarity as to its nature, though it derives a supply of nourishment from the 



322 Heustis on Hernia Cerebri. 

surrounding" parts; it seems to live and grow by its own independent powers; 
and the future structure which it may acquire, seems to depend on the opera- 
tion of its own vessels. When the organization of a gland becomes changed 
into the unnatural structure which is observable in tumours, it may be thought 
in some degree to contradict those observations; but in this case the substance 
of the gland is the matrix in which the tumour is formed." 

It unfortunately often happens with men of ardent minds and 
sprightly genius, that in their investigations after truth, or in the 
pursuit of a favourite hypothesis, some fitful and dazzling idea strikes 
their fancy with peculiar force, and is immediately seized upon as 
the golden key to unlock the storehouse of true knowledge and phi- 
losophy. Thus our great and much respected countryman, Dr. Rush, 
fancied that by his unity of disease, he was enabled to explain and 
elucidate every obscurity, and to reconcile every apparent diversity 
and contradiction in medical science: had he, moreover, been success- 
ful in discovering a unity of remedy, the grand consummation of the 
healing art would have been complete. There is still, however, one 
consolation left to the memory of departed worth, that, in this re- 
spect he has not been more unfortunate than his predecessors. What 
now remains of the fine wrought theories of Boerhaave, Cullen, 
Brown, and a host of others, built with so much ingenuity and la- 
bour ? Nothing but prostrate ruins, which, unable to support and 
maintain the edifice they were intended to perpetuate, lie neglected; 
and are passed unheeded, except as monuments of the fleeting dura- 
tion of man's boasted pride and ambition. 

In this way, I apprehend, Mr. Abernethy has been led astray, by 
attaching too much confidence to the doctrine of Mr. Hunter, in re- 
lation to the vitality of the blood. Yet, if I understand him correctly, 
there can be but little difference between a coagulum of blood acci- 
dentally formed in any part of the body, and a regularly organized sub- 
stance; since, according to his doctrine, the coagulum itself, in time, 
becomes organized, being furnished with nerves and vessels from the 
neighbouring parts. It would seem that an opinion so much at vari- 
ance with the observation and experience of almost every surgeon, 
would scarcely gain sufficient credit to stand in need of refutation 5 
yet, when a notion, however erroneous, has the sanction of authority 
to support it, it ceases to be trivial and unimportant. It must be 
familiar to every practitioner in surgery, that an effusion of blood, 
from wounds, or other causes, and the consequent formation of coa- 
gula in any part of the body, so far from becoming organized, and 
consolidated with the neighbouring parts, acts as extraneous matter; 



Heustis on Hernia Cerebri. 323 

if in small quantity, it is absorbed, as if the coagulum is too large to 
admit of being removed by the absorbents, it acts as an unnatural 
irritant, giving rise to inflammation and suppuration. Thus, we often 
observe, that a part of the body, that has been wounded and bruised, 
distended and tense with coagulated blood, thrown out from blood- 
vessels that have been ruptured by the violence. If the part be cut 
into, as is frequently necessary in wounds of the head, we find that 
this swelling is occasioned, in a great degree, by the cause here 
stated ; yet in a few days, in favourable cases, this effused blood is 
all taken up by the absorbents, and eliminated from the system as 
extraneous matter. In the early part of my practice I once attempt- 
ed to heal a deep incised wound full of coagulated blood; the wound 
had been received some considerable time before I saw it, and the 
coagulum was hard, and firmly united to the neighbouring parts. 
Finding it somewhat difficult to remove this coagulum, I brought the 
edges of the wound together by the interrupted suture; but I was 
disappointed in expecting a union by the first intention; the part in- 
flamed, became swollen and painful; I now found it necessary to 
open the wound and remove the coagulum, and subdue the inflam- 
mation and promote suppuration by the use of emollient poultices. 
So much for Messrs. Hunter's and Abernethy's coagulum becoming 
an organized portion of the body. 

In corroboration of the above opinion I am happy to adduce the 
testimony of Mr. Charles Bell. Upon this subject he remarks as 
follows: — 

" The observations which I have made, and the opinion I have formed, are 
so different from those of Mr. Abernethy, that I think myself called upon, in 
some degree to extend the consideration of the subject." * * * " I have dissect- 
ed a case very much resembling" that described by Mr. Abernethy, in which the 
section of the brain around the root of the tumour showed many spots of extra- 
vasation; and it would readily occur to any one, that this tumour had been oc- 
casioned by one of the larger vessels giving way, and pouring out a coagulum. 
But these spots of extravasated blood attend most ulcerations of the substance of 
the brain." * * * " Mr. Abernethy conceives that the bursting of the vessel within 
the brain is a consequence of the blow; but I have seen the disease arise after 
a venereal caries of the skull, in which the whole thickness of the bone had ex- 
foliated. Further, the surface of this tumour bleeds when torn or cut. Not only 
it bleeds if it be torn off, but the abraded surface bleeds. This is not like a 
coagulum. 2. It shrinks and collapses upon death, which is certainly a mark 
of a part having circulation within it. 3. I have a preparation of this disease, 
where an ulcer passes from its base into the lateral ventricle, and where the 
ulcer communicated outwardly, and yet no drop of blood or coagulum was seen 
upon the surface of the brain, or in the cavities. 4. It is not formed of concen- 



324 Heustis on Hernia Cerebri. 

trie lamina, as the coagulum of an aneurism is. The blood never bursts from 
its surface, as it should do even from a venous tumour, "which had power in the 
first instance to burst the membranes of the brain. It is affected like spongy 
granulation from caustic. A degree of compression, equal to the compression 
of a considerable artery, will not subdue it when its growth has got head. 5. It 
has a fibrous structure, and when it is dissolved in death, it hangs in shreds, 
not like a coagulum. Lastly, the peculiar disposition to this disease is not shown 
merely in the tumour, but is evident on the margin and inner side of the ulce- 
rated cavity." 

Some have contended that the external protrusion is vicarious of 
more serious internal injury, which would otherwise give rise to apo- 
plexy. Mr. Abernethy's opinion was, that this apoplexy would be 
occasioned by the effusion of blood into the substance of the brain, 
were it not that the deficiency of bone allows it to expand, by press- 
ing the surface of the brain and its membranes through the vacant 
space. This, however, is all extremely problematical. As the cavity 
of the cranium, in its natural state, affords no vacuum, should any 
morbid action take place in the substance of the brain, giving rise to 
the production of a tumour or excrescence, is it not fairly presuma- 
ble, from what takes place in other instances and situations, that the 
growth of the latter would be accompanied by a corresponding ab- 
sorption and diminution of the former? Such a growth would, doubt- 
less, be productive of derangement in the functions of the nervous 
system, and might, by its unnatural irritation, give rise to convul- 
sions, but without occasioning apoplexy by its general compression 
upon the encephalon. 

Much uncertainty still exists with respect to the mode of practice 
in this disease. Mr. Abernethy advises not to interfere with the 
treatment of the complaint, unless some bad symptoms should pre- 
cede the appearance or accompany the continuance of the tumour. 
But if the tumour continues to increase, and if the patient suffers a 
train of bad symptoms, apparently arising from irritation and pressure 
made on the brain, going upon the notion, that the coagulum, of which 
he supposes the fungus to consist, is enlarged internally, or that by 
plugging up the orifice in the bone, it prevents the escape of some 
fluid collected within the cranium, in such cases he advises to enlarge 
the opening in the bone in proportion to the extent and increase of 
the tumour. The only apprehension of Mr. Abernethy in relation to 
such practice, appears to be from excessive haemorrhage. " But al- 
though by thus allowing a free escape to the effusion of blood, we may 
prevent the injurious effects of its pressure on the brain, yet the de- 



Heustis on Hernia Cerebri. 325 

gree of haemorrhage may endanger the life of the patient." It is well 
that Mr. Abernethy "either feigned or felt" danger in any way from 
such practice, lest the young and inexperienced might have been led 
from his recommendation into a measure as painful and imprudent as 
it would probably be hazardous and unsuccessful. Yet I am far from 
thinking that Mr. Abernethy has attributed the danger to be appre- 
hended from this mode of treatment to the right cause; and as in the 
first instance he was wrong in theory, so, in the second, he is corres- 
pondingly erroneous in practice. Such a recommendation coming 
from a gentleman of less reputation than Mr. Abernethy, would be 
looked upon as grossly empirical and absurd. Thus, if we were to 
pursue the plan here suggested, " to enlarge the opening in propor- 
tion to the extent and increase of the tumour," we might go on remov- 
ing the portion of cranium circumscribing the excrescence, till the 
latter might exceed the bounds of all reasonable calculation; for as 
this tumour seems to be confined and limited in its extent by the un- 
yielding circumference of the opening, we may with probability pre- 
sume that were this limit to its expansion removed, the tumour would 
proportionably increase in its dimensions. Where the haemorrhage 
is considerable, or, in other words, where the growth of the hernia 
cerebri is rapid, Mr. Abernethy recommends the removal of the 
coagulum, or the tumour, and to expose the cavity in the brain, in 
order to learn whether suffering some sudden loss of blood to take 
place, together with the exposure of the bleeding vessel, might not 
produce a beneficial change, and a cessation of the haemorrhage, in 
the same way as the removal of the dressings from wounds in other 
instances, and the exposure of the bleeding vessels to the air, puts a 
stop to the further effusion of blood. This, however, appears to be 
completely hypothetical, unsupported by probability or experience. 

I come now to speak of the practice of removing such tumours by 
excision. It is now sufficiently ascertained that little danger is 
to be apprehended in the free removal of such tumours with the 
scalpel. The benefit thence resulting may be ascribed to two causes. 

1. The local depletion of the vessels of the part, caused by the hae- 
morrhage, in the same way as topical bleeding, by cupping, and 
leeches, relieves local inflammation in other instances and situations. 

2. The diminution of the quantity and impetus of blood to the part, 
in consequence of the lessened demand for the supply; for as the tu- 
mour is a morbid growth, every portion of this that is removed must 
proportionably lessen the extent and amount of diseased action. This 
practice has been long recommended in books, though but little pur- 
sued in practice. Mr. Charles Bell, in his Operative Surgery, says, 

No. VIII — August, 1829. 42 



326 Heustis on Hernia Cerebri. 

" the tumour should be cut off freely." It has been objected to this 
operation as a practice liable to produce dangerous and fatal haemor- 
rhage.* Such an accident, however, appears to be more imaginary 
than real. If there were any well-authenticated instances of death 
produced by such a cause, there would then be serious grounds for 
apprehension; but as no such cases have come within my knowledge, 
I must regard the objection as gratuitous and unfounded. I have 
myself repeatedly removed such excrescences with the knife, with- 
out any pain or inconvenience to the patient; and as to the haemor- 
rhage, it was very inconsiderable, the vessels of the part being small, 
and soon closing from exposure to the air. In confirmation of this 
practice, the following case is in point. It is quoted by Mr. Aber- 
nethy frOm the Memoires de VAcademie de Chirurgie. 

" A young man received a blow on the right parietal bone, which occasion- 
ed i fracture; some bone was removed, and a hernia cerebri was afterwards 
producedj which was repeatedly pared down with the knife. On the thirty- 
fifth day frun the accident, the patient having intoxicated himself, while in 
this state, slipt his hand under the dressings, and laying hold of the protrud- 
ing coagului , (fungus,) tore it away with violence. The next day the surgeon 
found that ai aost the whole of what he considered as corrupted brain was re- 
moved, and a acancy left so deep that he could see nearly to the corpus callo- 
sum. From this time forwards the parts went on healing, until they got quite 
well; but the patient continued to labour under a paralysis of the left side, 
which had supervened the day after he received the blow." 

As the inflammation surrounding the fungus is frequently attended 
with suppuration, and as the tumour by completely plugging up the 
opening in the bone, prevents the escape of the water, we hence see 
an additional reason for making a free excision of the tumour down 
to its base. Mr. Bell, in his surgical cases, says " he was obliged 
to shave away the tumour, and to push a lancet into its root as often 
as the stupor and other symptoms showed that matter was lodged 
there, by which the patient was uniformly relieved, and afterwards 
recovered."! 



* Speaking of the advice of Mr. Bell to cut the tumour freely, Dr. Dorsey 
says, " This, I conceive, could not answer any good purpose, and would pro- 
bably be productive of very copious hsemorrhagy, which in the exhausted state 
of the patient might prove fatal." 

■\ This recommendation of pushing a lancet into the substance of the brain, 
in order to arrive at the matter situated beneath, might appear rash and hazard- 
ous; but provided the brain near the origin of the nerves is not disturbed, there 
is no immediate danger to be apprehended from wounds of its convex surface: 
thus, in cases of hydrocephalus internus I have several times plunged an abscess 



Heustis on Hernia Cerebri. 327 

But there is another and more powerful way of controlling this 
morbid action, where the hernia cerebri is accessible and partial,